Provider Demographics
NPI:1427156454
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO UCLA HOSPITAL SYSTEM
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-794-8627
Mailing Address - Street 1:PHARMACY BUSINESS OFFICE
Mailing Address - Street 2:757 WESTWOOD PLAZA, ROOM B504E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7423
Mailing Address - Country:US
Mailing Address - Phone:310-794-7458
Mailing Address - Fax:310-794-7463
Practice Address - Street 1:200 MEDICAL PLAZA SUITE 426
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-794-7458
Practice Address - Fax:310-794-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE409753336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992436OtherPK
CA142156454Medicaid
CA1427156454Medicaid
CAPH0000237Medicaid