MEDICARE: UNIVERSITY OF CALIFORNIA LOS ANGELES

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	B4583035	CA

General Provider Information

NPI Number	:	1518353929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF CALIFORNIA LOS ANGELES

Provider Business Mailing Address
First Line	:	2627 E 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 E 3RD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4124
Country	:	US
Telephone Number	:	323-397-8080
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	KARLA GONZALEZ
Credential	:	M.D.
Telephone Number	:	323-397-8080

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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