Healthcare Provider Details

I. General information

NPI: 1992740450
Provider Name (Legal Business Name): USC OBSTETRICIANS AND GYNECOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE SUITE 220
PASADENA CA
91105-3150
US

IV. Provider business mailing address

1640 MARENGO ST SUITE 505
LOS ANGELES CA
90033-1036
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-3270
  • Fax: 323-225-6284
Mailing address:
  • Phone: 323-221-3270
  • Fax: 323-225-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAILA I MUDERSPACH
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 323-221-3270