Provider Demographics
NPI:1306111869
Name:UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-206-1826
Mailing Address - Street 1:LE CONTE AVE 12 430 CHS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LE CONTE AVE 12 430 CHS
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-206-1826
Practice Address - Fax:310-825-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119502281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren