Organization
UNIVERSITY OF SOUTHERN CALIFORNIA
Active
Parent organization
UNIVERSITY OF SOUTHERN CALIFORNIA
Other names
USC BREAST CANCER ANALYSIS LABORATORY
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF SOUTHERN CALIFORNIA
Authorized official
TODD DICKEY (SR VP - ADMINISTRATION)
(213) 740-8184
Entity
Organization
Contact information
Practice address
1441 EASTLAKE AVENUE, ROOM 5409, LOS ANGELES, CA 90033
(323) 865-0563
(323) 865-0122
Mailing address
PO BOX 513199, LOS ANGELES, CA 90051-1199
(323) 865-0563
(323) 865-0122
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D0684670
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0684670
MEDICARE ID - UNSPECIFIED
CA
01
—
690000015
MEDICARE RAILROAD
CA
01
—
CLF315998
STATE
CA
05
—
LAB84670F
—
CA
01
—
W7801B
MEDICARE CODE
CA
01
—
ZZZ09704Z
BLUE SHIELD CODE
CA
Enumeration date
03/14/2007
Last updated
09/18/2015
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