Healthcare Provider Details

I. General information

NPI: 1366401333
Provider Name (Legal Business Name): REGENTS UNIV OF CALIF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7400
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7400
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9308
  • Fax: 310-267-3516
Mailing address:
  • Phone: 310-267-9308
  • Fax: 310-267-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number930000165
License Number StateCA

VIII. Authorized Official

Name: MS. PAUL ALVIN STATON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 310-267-9308