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General NPI Number Information
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NPI Number | 1225364797
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Entity Type | Organization
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Legal Business Name | UCLA
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 924 WESTWOOD BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90024-2923
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Country | US
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Telephone | 310-794-0242
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Fax | 310-794-0244
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Provider Business Mailing Address
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Address Line | 842 PALMS BLVD
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City | VENICE
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State | CA
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Zip | 90291-3851
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Country | US
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Telephone | 310-794-0242
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Fax | 310-794-0244
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Authorized Official
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Title or Position | RESEARCH COORDINATOR
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Name | MS. ROSEANNA PAULINE MALONE
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Credential | NP
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Telephone | 310-794-0242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 18439
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License Number State | CA
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