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General NPI Number Information
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NPI Number | 1609249408
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 1260 15TH ST SUITE 1200
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City | SANTA MONICA
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State | CA
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Zip | 90404-1135
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Country | US
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Telephone | 310-794-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-794-7700
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Fax |
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Authorized Official
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Title or Position | DEPT. CHAIR
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Name | DR. MARK S. LITWIN
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Credential | MD
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Telephone | 310-206-8183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | CA
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