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General NPI Number Information
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NPI Number | 1427181577
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF SOUTHERN CALIFORNIA
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 1200 NORTH STATE STREET BARRACKS D,
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-226-6507
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Fax | 323-226-7069
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Provider Business Mailing Address
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Address Line | PO BOX 513199
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City | LOS ANGELES
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State | CA
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Zip | 90033
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Country | US
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Telephone | 323-226-6507
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Fax | 323-226-7069
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Authorized Official
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Title or Position | SR VP ADMINISTRATION
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Name | TODD DICKEY
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Credential |
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Telephone | 213-740-8184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D0714357
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License Number State | CA
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