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General NPI Number Information
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NPI Number | 1750698502
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Entity Type | Organization
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Legal Business Name | THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 10880 WILSHIRE BLVD SUITE 1800
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City | LOS ANGELES
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State | CA
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Zip | 90024-4101
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Country | US
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Telephone | 310-794-0619
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Fax | 310-794-2808
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Provider Business Mailing Address
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Address Line | 10880 WILSHIRE BLVD SUITE 1800
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City | LOS ANGELES
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State | CA
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Zip | 90024-4101
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Country | US
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Telephone | 310-794-0619
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Fax | 310-794-2808
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Authorized Official
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Title or Position | PROF. PSYCHIATRY AND BEHAVIORAL SCI
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Name | MR. STEVEN JOSEPH SHOPTAW
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Credential | PHD
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Telephone | 310-794-6206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PFY13300
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License Number State | CA
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