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General NPI Number Information
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NPI Number | 1457600165
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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 | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 200 UCLA MEDICAL PLZ SUITE B114
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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 | 310-983-1436
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Fax |
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Provider Business Mailing Address
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Address Line | 200 UCLA MEDICAL PLZ STE B114
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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 | 310-983-1425
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Fax |
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Authorized Official
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Title or Position | RESIDENT
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Name | AMIR ENTEZARI
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Credential | M.D
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Telephone | 949-677-4790
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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 | A122478
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License Number State | CA
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