Healthcare Provider Details

I. General information

NPI: 1346591534
Provider Name (Legal Business Name): UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO STREET
LOS ANGELES CA
90033-0107
US

IV. Provider business mailing address

1500 SAN PABLO STREET
LOS ANGELES CA
90033-0107
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-8444
  • Fax:
Mailing address:
  • Phone: 323-442-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number930000912
License Number StateCA

VIII. Authorized Official

Name: MR. TODD R. DICKEY
Title or Position: SR. V.P. ADMINISTRATION
Credential:
Phone: 213-740-7922