Healthcare Provider Details

I. General information

NPI: 1306111869
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LE CONTE AVE 12 430 CHS
LOS ANGELES CA
90095-1752
US

IV. Provider business mailing address

LE CONTE AVE 12 430 CHS
LOS ANGELES CA
90095-1752
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-1826
  • Fax: 310-825-9832
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberA119502
License Number StateCA

VIII. Authorized Official

Name: SHERIN DEVASKAR
Title or Position: MD
Credential:
Phone: 310-206-1826