Healthcare Provider Details

I. General information

NPI: 1609131655
Provider Name (Legal Business Name): MATTEL CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MATTEL CHILDRENS HOSPITAL AT UCLA DAVID GEFFEN SCHOOL OF MEDICINE, BOX 951752
LOS ANGELES CA
90095-1752
US

IV. Provider business mailing address

MATTEL CHILDRENS HOSPITAL AT UCLA DAVID GEFFEN SCHOOL OF MEDICINE, 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 Code282NC2000X
TaxonomyChildren's Hospital
License NumberA118603
License Number StateCA

VIII. Authorized Official

Name: DR. ISIDRO SALUSKI
Title or Position: CHAIR, PEDIATRIC NEPHROLOGY
Credential: M.D.
Phone: 310-206-6987