Healthcare Provider Details

I. General information

NPI: 1316318843
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2424 WILSHIRE BLVD
SANTA MONICA CA
90403-5806
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 310-828-4530
  • Fax:
Mailing address:
  • Phone: 310-828-4530
  • 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: BERNARD J KATZ
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 310-459-2363