Healthcare Provider Details

I. General information

NPI: 1437520020
Provider Name (Legal Business Name): REGENTS UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY SUITE 100
MARINA DEL REY CA
90292-5423
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-827-3700
  • Fax:
Mailing address:
  • Phone: 310-827-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BERNARD KATZ
Title or Position: DIRECTOR
Credential:
Phone: 310-459-2363