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General NPI Number Information
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NPI Number | 1780926634
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Entity Type | Organization
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Legal Business Name | RONALD REGAN UCLA MEDICAL CENTER
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 8603 JELLICO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91325-3103
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Country | US
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Telephone | 818-445-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 8603 JELLICO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91325-3103
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Country | US
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Telephone | 818-445-4401
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER II
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Name | SUSANA ISABEL PREZA-SCAVO
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Credential | NURSE PRACTITIONER
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Telephone | 310-267-9812
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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 | 21427
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License Number State | CA
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