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General NPI Number Information
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NPI Number | 1851661300
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Entity Type | Organization
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Legal Business Name | UCLA FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 1920 COLORADO BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90095
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Country | US
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Telephone | 310-206-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 10940 WILSHIRE BLVD 700
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City | LOS ANGELES
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State | CA
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Zip | 90024-3915
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Country | US
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Telephone | 310-206-3340
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Fax | 310-794-0723
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Authorized Official
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Title or Position | CLINICAL PHARMACIST
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Name | SHIRLEY LIEHENG WONG
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Credential | PHARMD
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Telephone | 310-206-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 64122
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License Number State | CA
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