Organization Name:  UC REGENTS UCLA DEPARTMENT OF MEDICINE PROFESSIONAL GROUP


Practice Location:
UC REGENTS UCLA DEPT OF MED PROF GRP 100 MED PLAZA SUITE 290,450,455,490,525,550,510,700 LOS ANGELES, CA 90095 US
Tel: 310-794-4955  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
X	207K00000X	Physicians Allergy & Immunology
X	207Q00000X	Physicians Family Medicine
X	207R00000X	Physicians Internal Medicine
X	207RA0201X	Physicians Internal Medicine
X	207RC0000X	Physicians Internal Medicine
X	207RE0101X	Physicians Internal Medicine
X	207RG0100X	Physicians Internal Medicine
X	207RG0300X	Physicians Internal Medicine
X	207RH0003X	Physicians Internal Medicine
X	207RI0001X	Physicians Internal Medicine
X	207RI0008X	Physicians Internal Medicine
X	207RI0200X	Physicians Internal Medicine
X	207RN0300X	Physicians Internal Medicine
X	207RP1001X	Physicians Internal Medicine
X	207RR0500X	Physicians Internal Medicine

Other Provider Identifiers:

Issuer	Number	State	Type
MEDICARE PROVIDER GROUP #	W11854O	CA	01
MEDICARE PROVIDER GROUP #	W11854AA	CA	01
MEDICARE PROVIDER GROUP #	W11854F	CA	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin