Healthcare Provider Details

I. General information

NPI: 1962800235
Provider Name (Legal Business Name): THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W 3RD ST 100
LOS ANGELES CA
90057-1944
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 213-353-7005
  • Fax:
Mailing address:
  • Phone: 213-353-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 9656
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU 2947
License Number StateCA

VIII. Authorized Official

Name: GERALD BERKE
Title or Position: PROF & CHAIR
Credential: MD
Phone: 310-825-5179