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General NPI Number Information
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NPI Number | 1992740450
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Entity Type | Organization
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Legal Business Name | USC OBSTETRICIANS AND GYNECOLOGISTS, INC.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 800 FAIRMOUNT AVE SUITE 220
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City | PASADENA
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State | CA
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Zip | 91105-3150
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Country | US
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Telephone | 323-221-3270
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Fax | 323-225-6284
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Provider Business Mailing Address
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Address Line | 1640 MARENGO ST SUITE 505
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City | LOS ANGELES
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State | CA
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Zip | 90033-1036
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Country | US
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Telephone | 323-221-3270
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Fax | 323-225-6284
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LAILA I MUDERSPACH
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Credential | M.D.
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Telephone | 323-221-3270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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