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General NPI Number Information
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NPI Number | 1104644988
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE # A0-156 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-0834
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | KATHERINE HALE
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Credential |
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Telephone | 310-301-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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