Provider Demographics
NPI:1780926634
Name:RONALD REGAN UCLA MEDICAL CENTER
Entity type:Organization
Organization Name:RONALD REGAN UCLA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER II
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:PREZA-SCAVO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:310-267-9812
Mailing Address - Street 1:8603 JELLICO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3103
Mailing Address - Country:US
Mailing Address - Phone:818-445-4401
Mailing Address - Fax:
Practice Address - Street 1:8603 JELLICO AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3103
Practice Address - Country:US
Practice Address - Phone:818-445-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21427282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital