Healthcare Provider Details

I. General information

NPI: 1336534908
Provider Name (Legal Business Name): HARBOR UCLA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST OPHTHALMOLOGY CLINIC BOX 6
CARSON CA
90810-1408
US

IV. Provider business mailing address

1000 W CARSON ST OPHTHALMOLOGY CLINIC BOX 6
CARSON CA
90810-1408
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2735
  • Fax:
Mailing address:
  • Phone: 310-222-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number363LXF0000X
License Number StateCA

VIII. Authorized Official

Name: EVANGELINE OJALES
Title or Position: NP
Credential: NURSE PRACTITIONER
Phone: 818-693-4458