Healthcare Provider Details

I. General information

NPI: 1366275844
Provider Name (Legal Business Name): REGENTS UNIV OF CALIF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 VETERAN AVE
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

10920 WILSHIRE BLVD STE 1700
LOS ANGELES CA
90024-6542
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7955
  • Fax:
Mailing address:
  • Phone: 414-617-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LEHR WALLACE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 310-794-8627