Provider Demographics
NPI:1285893776
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ASSOCIATE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAMATHI
Authorized Official - Suffix:
Authorized Official - Credentials:ANP, PHD, FAAN
Authorized Official - Phone:310-206-7433
Mailing Address - Street 1:545 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2101
Mailing Address - Country:US
Mailing Address - Phone:213-673-4849
Mailing Address - Fax:213-673-4581
Practice Address - Street 1:545 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2101
Practice Address - Country:US
Practice Address - Phone:213-673-4849
Practice Address - Fax:213-673-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000279261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70366FOtherEAPC EXPANDED ACCESS TO PRIMARY CARE