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General NPI Number Information
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NPI Number | 1629375845
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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 | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 100 STEIN PLZ 1-340
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City | LOS ANGELES
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State | CA
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Zip | 90095-7065
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Country | US
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Telephone | 310-825-5000
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 55632
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City | LOS ANGELES
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State | CA
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Zip | 90074-2939
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Country | US
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Telephone | 310-825-5000
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | BARTLY J MONDINO
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Credential | MD
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Telephone | 310-825-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | CA
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