MEDICARE: REGENTS UNIV OF CALIF 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	283Q00000X	Psychiatric Hospital	930000204	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952308363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS UNIV OF CALIF LOS ANGELES

Provider Business Mailing Address
First Line	:	10920 WILSHIRE BLVD
Second Line	:	STE 1700
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6502
Country	:	US
Telephone Number	:	310-948-7371
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 UCLA MEDICAL PLAZA
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-267-9308
Fax Number	:	310-267-3516

Authorized Official
Title or Position	:	CFO
Name	:	TAMMY LEHR WALLACE
Credential	:
Telephone Number	:	310-267-9307

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/04/2025

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