Healthcare Provider Details

I. General information

NPI: 1477511046
Provider Name (Legal Business Name): UCLA FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA SUITE 220
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

FILE 2939
LOS ANGELES CA
90074-2939
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8941
  • Fax:
Mailing address:
  • Phone: 310-301-8709
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK DOWLING
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 310-825-8234