MEDICARE: UCLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1184851016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCLA

Provider Business Mailing Address
First Line	:	1041 GLENDON AVE. #3180
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	714-420-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 GLENDON AVE. #3180
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	714-420-5115
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	DR. JODI FRIEDMAN
Credential	:	MD
Telephone Number	:	310-825-7375

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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