Healthcare Provider Details

I. General information

NPI: 1255660171
Provider Name (Legal Business Name): UCLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE RM A2-383 CHS PEDIATRICS BOX 951752
LOS ANGELES CA
90095-1752
US

IV. Provider business mailing address

MATTEL CHILDREN'S HOSPITAL AT UCLA BOX 951752
LOS ANGELES CA
90095-1752
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6987
  • Fax: 310-825-0442
Mailing address:
  • Phone: 310-206-6987
  • Fax: 310-825-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberA93828
License Number StateCA

VIII. Authorized Official

Name: DR. ORA YADIN
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 310-206-6987