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Organization
USC OBSTETRICIANS AND GYNECOLOGISTS, INC.
Active
Organization
USC OBSTETRICIANS AND GYNECOLOGISTS, INC.
Active
Other names
USC Ob/Gyn, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
LAILA I MUDERSPACH M.D. (PRESIDENT/CEO)
(323) 221-3270
Entity
Organization
Contact information
Practice address
800 FAIRMOUNT AVE, SUITE 220, PASADENA, CA 91105-3150
(323) 221-3270
(323) 225-6284
Mailing address
1640 MARENGO ST, SUITE 505, LOS ANGELES, CA 90033-1036
(323) 221-3270
(323) 225-6284
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0056150
—
CA
05
—
GR0056151
—
CA
05
—
GR0056152
—
CA
05
—
GR0056153
—
CA
05
—
GR0056154
—
CA
05
—
GR0056155
—
CA
01
—
ZZZ01352Z
BLUE SHIELD
CA
01
—
ZZZ02127Z
BLUE SHIELD
CA
01
—
ZZZ02683Z
BLUE SHILELD
CA
01
—
ZZZ56147Z
BLUE SHIELD
CA
01
—
ZZZ67024Z
BLUE SHIELD
CA
01
—
ZZZ67025Z
BLUE SHIELD
CA
Enumeration date
06/18/2006
Last updated
03/28/2008
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