Provider Demographics
NPI:1962800235
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROF & CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-825-5179
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:213-353-7005
Mailing Address - Fax:
Practice Address - Street 1:2100 W 3RD ST
Practice Address - Street 2:100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1944
Practice Address - Country:US
Practice Address - Phone:213-353-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2947231H00000X
CASP 9656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty