Healthcare Provider Details

I. General information

NPI: 1932336211
Provider Name (Legal Business Name): UCLA HEMATOLOGY AND ONCOLOGY, SANTA MONICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD SUITE 600
SANTA MONICA CA
90404-2023
US

IV. Provider business mailing address

PO BOX 951736 32-136 CHS
LOS ANGELES CA
90095-1736
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5471
  • Fax: 310-829-6192
Mailing address:
  • Phone: 310-829-5471
  • Fax: 310-829-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. FARAH ELAHI
Title or Position: CHAIRMAN, CAO
Credential: M.D.
Phone: 310-825-0630