Provider Demographics
NPI:1316190788
Name:UCLA DAVID GERFFEN
Entity type:Organization
Organization Name:UCLA DAVID GERFFEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DRIECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GOLAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERENJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-478-3711
Mailing Address - Street 1:BOX 951722, 12-138 CHS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-825-6816
Mailing Address - Fax:310-825-3879
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-3585
Practice Address - Fax:215-762-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1936988282N00000X
CAA117646282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital