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Organization
UCLA DEPARTMENT OF PEDIATRIC GROUP PRACTICE
Active
Organization
UCLA DEPARTMENT OF PEDIATRIC GROUP PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERIN DEVASKAR MD (INTERIM EXECUTIVE CHAIR)
(310) 825-5095
Entity
Organization
Contact information
Practice address
200 MEDICAL PLZ, SUITE 265, LOS ANGELES, CA 90095-0001
(310) 825-0867
(310) 206-5146
Mailing address
10833 LE CONTE AVE, 22-474 MDCC, LOS ANGELES, CA 90095-1752
(310) 825-6196
(310) 825-5834
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
677319
CA
363LF0000X
Family Nurse Practitioner
Primary
19341
CA
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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