=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013342948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UCLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2013
-----------------------------------------------------
Last Update Date | 09/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 CHARLES E YOUNG DR SOUTH ROOM 259, BRAIN MAPPING CENTER
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-754-6518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 CHARLES E YOUNG DR SOUTH ROOM 259, BRAIN MAPPING CENTER
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | GENE BLOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-825-2151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 110110000034410
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------