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General NPI Number Information
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NPI Number | 1285893776
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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 | 06/09/2008
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 545 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90013-2101
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Country | US
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Telephone | 213-673-4849
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Fax | 213-673-4581
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Provider Business Mailing Address
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Address Line | 545 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90013-2101
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Country | US
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Telephone | 213-673-4849
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Fax | 213-673-4581
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Authorized Official
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Title or Position | ADMINISTRATOR/ASSOCIATE DEAN
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Name | ADELINE NYAMATHI
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Credential | ANP, PHD, FAAN
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Telephone | 310-206-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 960000279
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License Number State | CA
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