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General NPI Number Information
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NPI Number | 1245941848
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Entity Type | Organization
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Legal Business Name | REGENTS UNIV OF CALIF LOS ANGELES
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 200 UCLA MEDICAL PLZ STE 130
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City | LOS ANGELES
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State | CA
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Zip | 90095-8344
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Country | US
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Telephone | 310-267-8503
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Fax |
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Provider Business Mailing Address
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Address Line | 757 WESTWOOD PLZ # B531
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-267-8503
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. TAMMY LEHR WALLACE
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Credential |
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Telephone | 310-794-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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