Healthcare Provider Details

I. General information

NPI: 1184769606
Provider Name (Legal Business Name): USC UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

2146 S BENTLEY AVE APT 4
LOS ANGELES CA
90025-5755
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5226
  • Fax:
Mailing address:
  • Phone: 408-642-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1494
License Number StateMA

VIII. Authorized Official

Name: CHERYL LOLLICH
Title or Position: DIRECTOR OF SPORTS MEDICINE
Credential: ATC
Phone: 323-442-5226