Healthcare Provider Details

I. General information

NPI: 1831497270
Provider Name (Legal Business Name): REGENTS UNIV OF CALIF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE A -744
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-1730
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1323
  • Fax: 310-794-1457
Mailing address:
  • Phone: 310-267-9308
  • Fax: 310-267-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number930000165
License Number StateCA

VIII. Authorized Official

Name: MRS. TAMMY LEHR WALLACE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 310-267-9307