Basic Information
| Provider Information | |||||||||
| NPI: | 1093009151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USC UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1027 N EDINBURGH AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900466023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235605773 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1520 SAN PABLO ST | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900335310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234425100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2011 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARLSTON | ||||||||
| AuthorizedOfficialFirstName: | FREDRICK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3234425100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | NP20259 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.