NPIMap

Organization Active NPI

Regents Univ of Calif Los Angeles

Doing business as Ronald Reagan UCLA - Medical Plaza Level I Pharmacy

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1275633224
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHE40977 Issued in CA
Legal business name
REGENTS UNIV OF CALIF LOS ANGELES
Doing business as
Ronald Reagan UCLA - Medical Plaza Level I Pharmacy
Practice address
200 UCLA Medical PLZ
Suite 135
Los Angeles, CA 90095-6949
Phone
(310) 794-1176
Fax
(310) 794-1187
NPI assigned
Sep 22, 2006
Last updated
Jul 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Authorized official

Name
Tammy Wallace
Title
Cfo UCLA Hospital System
Phone
(310) 794-8627

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHE40977 CA Primary

Addresses

Primary practice location

200 UCLA Medical PLZ
Suite 135
Los Angeles, CA 90095-6949

Mailing address

Pharmacy Business Ofc
757 Westwood Plaza, Room B504E
Los Angeles, CA 90095-7423
Phone (310) 267-8517

Other identifiers 3

IdentifierTypeStateIssuer
1275633224MedicaidCA
PH0000235MedicaidCA
1992432OtherPK

Other names 1

  • Ronald Reagan UCLA - Medical Plaza Level I Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930016817 CA DME Supplier - Pharmacy 6901856186 1 other NPI on this enrollment
Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Michael C Graves MD56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

757 Westwood Plz
Ofc
Los Angeles, CA 90095
Phone (310) 267-8653

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
California Rehabilitation InstituteLos Angeles, CA, CCN 053039 Hospital 5% Or Greater Direct Ownership Interest (10.9%) Dec 1, 2015
UCLA West Valley Medical CenterWest Hills, CA, CCN 050481 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 29, 2024
Accentcare UCLA Health LLCWest Hills, CA, CCN 057761 Home health agency 5% Or Greater Indirect Ownership Interest (30%) May 31, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1275633224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PHARMACY BUSINESS OFC",
            "address_2": "757 WESTWOOD PLAZA, ROOM B504E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900957423",
            "telephone_number": "310-267-8517",
            "fax_number": "310-267-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ",
            "address_2": "SUITE 135",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900956949",
            "telephone_number": "310-794-1176",
            "fax_number": "310-794-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS UNIV OF CALIF LOS ANGELES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CFO UCLA HOSPITAL SYSTEM",
        "authorized_official_telephone_number": "310-794-8627"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHE40977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275633224",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH0000235",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992432",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ronald Reagan UCLA - Medical Plaza Level I Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.