MEDICARE: OLIVE VIEW UCLA MEDICAL CENTER

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	251G00000X	Community Based Hospice Care Agency	A69455	CA

General Provider Information

NPI Number	:	1508924945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE VIEW UCLA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	10125 BROMONT AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-1147
Country	:	US
Telephone Number	:	818-252-5686
Fax Number	:	818-252-7187

Provider Business Practice Location Address
First Line	:	10125 BROMONT AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-1147
Country	:	US
Telephone Number	:	818-252-5686
Fax Number	:

Authorized Official
Title or Position	:	CHIEF, DEPARTMENT OF ANESTHESIOLOG
Name	:	DR. RIMA MATEVOSIAN
Credential	:	M.D.
Telephone Number	:	818-364-4350

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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