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General NPI Number Information
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NPI Number | 1992475032
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIV OF CALIFORNIA
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1131 WILSHIRE BLVD. SUITE 202
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City | LOS ANGELES
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State | CA
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Zip | 90404
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Country | US
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Telephone | 424-259-7705
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Fax | 310-260-0105
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Provider Business Mailing Address
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Address Line | 757 WESTWOOD PLZ
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-297-9308
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TAMMY LEHR WALLACE
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Credential |
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Telephone | 310-794-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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