| Program: | Name: | Fee: | Fax #: |
| Anesthesia | Lucelva Mendez | $50 standard form
$75 form filled out by program director | 310-267-3766 |
| Emergency Medicine | Jennifer Cassidy | $50 (payable by check only) | 310-794-0599 |
| Family Medicine | Evelyn Barajas | $50 standard form and/or letter of verification
$100 standard form including request for hospital seal
$125 notarized
| 310-453-5106 |
| FM-Addiction Medicine | Evelyn Barajas | $50 standard form and/or letter of verification
$100 standard form including request for hospital seal
$125 notarized | 310-453-5106 |
| FM-Sports Medicine | Evelyn Barajas | $50 standard form and/or letter of verification
$100 standard form including request for hospital seal
$125 notarized | 310-453-5106 |
| Internal Medicine | DOM Verification | $50 | |
| IM-Allergy/Immunology | Nelli Khatchatryan | | 310-825-9832 |
| IM-Cardiology | Desiree Valeriano | $75 | 310-206-9133 |
| IM-Dermatology | Hanna Lambertson | | 310-825-3613 |
| IM-Endocrinology | Jayamalee De Silva | | 310-312-0546 |
| IM-Gastroenterology | Trisha Navarro | $50 standard form
$100 custom verification letter | 310-267-1861 |
| IM-Geriatrics | Belen Ycong | | 310-794-2199 |
| IM-Hematology/Oncology | Ira Sarian | $75 for outside agencies and institutions | 310-206-3289 |
| IM-Hospice & Palliative | Robin Catino | | 310-268-4818 |
| IM-Infectious Diseases | Izumi Shitoma | | 310-825-3632 |
| IM-Nephrology | Ruth Manley | $100 for outside agencies and institutions | 310-825-6309 |
| IM-Preventive Medicine | Madeline Haley | | 310-267-3840 |
| IM-Pulmonary/Critical Care | Heather Draper | $50 standard form
$75 form filled out by program director | 310-206-8622 |
| IM-Rheumatology | Gabriel Valdivia | | 310-206-8606 |
| IM-Sleep Medicine | Heather Draper | $50 standard form
$75 form filled out by program director | 310-206-8622 |
| Medicine-Pediatrics | DOM Verification | | 310-267-3840 |
| Neurology (Residency) | Rebecca Bernstein
| $50 for outside agencies and institutions | 310-206-4733 |
| Neurology (Fellowship) | Jennifer Martinez | | |
| Neurosurgery | Colleen Bruton | $30 program coordinator signature
$50 program director signature
$50 hospital seal
$60 custom letter | 310-267-2707 |
| Neurocritical Care (Fellowship) | Mireya Consiglio | | 310-267-3841 |
| OB/Gyn (Residency) | Nicole Santos | $50 standard form
$75 form filled out by Program Director
$100 notarized | 310-206-7186 |
| OB/Gyn (Fellowship) | Yissel Rojas | $50 standard form
$75 form filled out by Program Director
$100 notarized | 310-206-7186 |
| Ophthalmology | Debbie Sato | | 310-825-4617 |
| Orthopaedic Surgery | Connie Sams | $50 | 310-825-1311 |
| Pathology (Residency) | Heidi Martinez | $30 standard letter
$40 filled out by the program director
$50 notarized Please note: beginning February 1st, 2022, the new rates will be: $50 standard letter
$75 filled out by the program director
$100 notarized | 310-267-2058 |
| Path - Bloodbanking/Transfusion Medicine Path - Hematopathology | Xiaojian (Jayne) Lu | $30 standard letter
$40 filled out by the program director
$50 notarized Please note: beginning February 1st, 2022, the new rates will be: $50 standard letter
$75 filled out by the program director
$100 notarized | |
| Path - Cytopathology Path - Dermatopathology Path - Molecular Genetic Pathology Path - Neuropathology | Xiaojian (Jayne) Lu | $30 standard letter
$40 filled out by the program director
$50 notarized Please note: beginning February 1st, 2022, the new rates will be: $50 standard letter
$75 filled out by the program director
$100 notarized | |
| Pediatrics (Residency) | Savannah Downey Pediatrics Residency | | |
| Peds - Allergy and Immunology | Nelli Khatchatryan | | |
| Peds - Child Neurology | Leedun Solachnek | | |
| Peds - Developmental-Behavioral Pediatrics | Sabrina Luker | | |
| Peds - Neonatal-Perinatal Medicine | Reginald Mateo | | |
| Pediatric Cardiology | Sabrina Luker | | |
| Pediatric Critical Care Medicine | Leedun Solachnek | | |
| Pediatric Hematology and Oncology | Sabrina Luker | | |
| Pediatric Endocrinology | Reginald Mateo | | |
| Pediatric Rheumatology | Sabrina Luker | | |
| Psychiatry (Residency & Fellowships) | Denise Aguinaldo | | 310-825-0340 |
| Radiation Oncology | Kathy Rose | | 310-794-1984 |
| Radiology (Residency & Fellowships) | Evelyn Velasco | $50 standard letter
$100 filled out by the program director
$150 notarized | 310-267-2059 |
| Surgery-General | Chi Quach | $75 | 310-267-0369 |
| Surgery-Head & Neck | Nicole Santos | | 310-794-8492 |
| Surgery-Plastic | Bryan Carrigan | | 310-825-5582 |
| Surgery-Thoracic | Desiree Valeriano | | 310-267-0369 |
| Surgery-Vascular | Maria Velasco | $50 for outside agencies and institutions | 310-267-0189 |
| Urology (Residency) | Nicole Santos | $50 standard form
$75 form filled out by Program Director
$100 notarized | 310-206-7186 |
| Urology (Fellowship) | Yissel Rojas | $50 standard form
$75 form filled out by Program Director
$100 notarized | 310-206-7186 |
