Basic Information
| Provider Information | |||||||||
| NPI: | 1164808986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCLA FAMILY MEDICINE RESIDENCY PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 COLORADO AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103194700 | ||||||||
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| Address1: | 1920 COLORADO AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103194700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | MICHEL | ||||||||
| AuthorizedOfficialFirstName: | HABAKUK | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3103194700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.