1326031345 NPI number — REGENTS OF THE UNIVERSITY OF CA

Table of content: (NPI 1326031345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326031345 NPI number — REGENTS OF THE UNIVERSITY OF CA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF CA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REGENTS UCDPBG SURGERY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326031345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 2600
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95820-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-9200
Provider Business Mailing Address Fax Number:
916-734-9661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7313
Provider Business Practice Location Address Fax Number:
916-734-2919
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIEFKIN
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
916-734-1166

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA4168 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CI4127 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CN4400 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CR0028 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DE7275 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0021048 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN4844 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GNP000070 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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