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General NPI Number Information
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NPI Number | 1306232020
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Entity Type | Organization
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Legal Business Name | HARBOR UCLA MEDICAL CENTER
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 100 W. CARSON STREET OPHTHALMOLOGY CLINIC BOX 6
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City | TORRANCE
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State | CA
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Zip | 90502
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Country | US
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Telephone | 310-222-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 550 N FIGUEROA ST APT 5011
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City | LOS ANGELES
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State | CA
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Zip | 90012-3393
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Country | US
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Telephone | 818-693-4458
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Fax |
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Authorized Official
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Title or Position | NP
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Name | EVANGELINE OJALES
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Credential | NURSE PRACTITIONER
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Telephone | 818-693-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 95001563
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License Number State | CA
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