| 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 |
D. Liane Nash |
$50 standard form
$75 form filled out by program director
$100 notarized |
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 |
