Healthcare Provider Details

I. General information

NPI: 1033516943
Provider Name (Legal Business Name): UC REGENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE
LOS ANGELES CA
90095-1752
US

IV. Provider business mailing address

10833 LE CONTE AVE
LOS ANGELES CA
90095-1752
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5904
  • Fax: 310-206-8616
Mailing address:
  • Phone: 310-825-5904
  • Fax: 310-206-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. SHERIN DEVASKAR
Title or Position: EXECUTIVE CHAIR
Credential: M.D..
Phone: 310-825-5095