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Organization
UC REGENTS
Active
Organization
UC REGENTS
Active
Other names
UCLA FAMILY HEALTH CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE ANN HALE (DIRECTOR OF ACCOUNTING)
(310) 301-5311
Entity
Organization
Contact information
Practice address
1920 COLORADO AVE, SANTA MONICA, CA 90404-3414
(310) 319-4700
(310) 301-8751
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 301-8713
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR005503G
—
CA
05
—
ZZZP1939Z
—
CA
Enumeration date
05/03/2006
Last updated
03/26/2024
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