Basic Information
| Provider Information | |||||||||
| NPI: | 1558662999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCLA MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | UCLA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 WESTWOOD BLVD | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLZ | ||||||||
| Address2: | DEPT OF ANESTHESIOLOGY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678655 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | STEADMAN | ||||||||
| AuthorizedOfficialFirstName: | RANDOLPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM RESIDENCY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3108254321 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | A106217 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.