Healthcare Provider Details

I. General information

NPI: 1093009151
Provider Name (Legal Business Name): USC UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST SUITE 1000
LOS ANGELES CA
90033-5310
US

IV. Provider business mailing address

1027 N EDINBURGH AVE APT 6
WEST HOLLYWOOD CA
90046-6023
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5100
  • Fax:
Mailing address:
  • Phone: 323-560-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberNP20259
License Number StateCA

VIII. Authorized Official

Name: FREDRICK A CARLSTON
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 323-442-5100