MEDICARE: THE REGENTS OF THE 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
1	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437117074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REGENTS OF THE 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	:	300 UCLA MEDICAL PLZ STE B200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8346
Country	:	US
Telephone Number	:	310-794-1195
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	KATHERINE HALE
Credential	:
Telephone Number	:	310-301-5311

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/02/2024

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Directions to “THE REGENTS OF THE UNIVERSITY OF CALIFORNIA ” Practice Location

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