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NPI Code Detail

MEDICARE: REGENTS UNIVERSITY OF CALIFORNIA

MEDICARE: REGENTS UNIVERSITY OF CALIFORNIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0207XMobile Mammography Clinic/Center

General Provider Information

NPI Number : 1407501877
Entity Type Code : Organization
Provider Name (Legal Business Name) : REGENTS UNIVERSITY OF CALIFORNIA
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2211 MICHIGAN AVE
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-3905
Country : US
Telephone Number : 310-586-9000
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF ACCOUNTING
Name : KATHERINE HALE
Credential :
Telephone Number : 310-301-5311
Provider Enumeration Date : 02/15/2022
Last Update Date : 02/15/2022

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Directions to “REGENTS UNIVERSITY OF CALIFORNIA ” Practice Location

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