Healthcare Provider Details

I. General information

NPI: 1285893776
Provider Name (Legal Business Name): REGENTS UNIV OF CALIF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

IV. Provider business mailing address

545 S SAN PEDRO ST
LOS ANGELES CA
90013-2101
US

V. Phone/Fax

Practice location:
  • Phone: 213-673-4849
  • Fax: 213-673-4581
Mailing address:
  • Phone: 213-673-4849
  • Fax: 213-673-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number960000279
License Number StateCA

VIII. Authorized Official

Name: ADELINE NYAMATHI
Title or Position: ADMINISTRATOR/ASSOCIATE DEAN
Credential: ANP, PHD, FAAN
Phone: 310-206-7433