NPIMap

Organization Active NPI

UCLA Department of Pediatric Group Practice

  • Family Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1093025355
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19341 Issued in CA
Legal business name
UCLA DEPARTMENT OF PEDIATRIC GROUP PRACTICE
Practice address
200 Medical PLZ
Suite 265
Los Angeles, CA 90095-0001
Phone
(310) 825-0867
Fax
(310) 206-5146
NPI assigned
Oct 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sherin Devaskar, MD
Title
Interim Executive Chair
Phone
(310) 825-5095

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0200X 677319 CA
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 19341 CA Primary

Addresses

Primary practice location

200 Medical PLZ
Suite 265
Los Angeles, CA 90095-0001

Mailing address

10833 Le Conte Ave
22-474 MDCC
Los Angeles, CA 90095-1752
Phone (310) 825-6196

National Provider Directory

National Provider Directory
Tax ID family
UCLA Dept of Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287532800000",
    "number": "1093025355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "22-474 MDCC",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900951752",
            "telephone_number": "310-825-6196",
            "fax_number": "310-825-5834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PLZ",
            "address_2": "SUITE 265",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-825-0867",
            "fax_number": "310-206-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UCLA DEPARTMENT OF PEDIATRIC GROUP PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2010-10-20",
        "status": "A",
        "authorized_official_last_name": "DEVASKAR",
        "authorized_official_first_name": "SHERIN",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE CHAIR",
        "authorized_official_telephone_number": "310-825-5095",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Pediatrics",
            "state": "CA",
            "license": "677319",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "19341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.