1114180635 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

Table of content: (NPI 1114180635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114180635 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF CALIFORNIA
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:
Provider Other Organization Name Type Code:
6
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:
1114180635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3671 BUSINESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95820-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-6637
Provider Business Mailing Address Fax Number:
916-734-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3671 BUSINESS DR
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:
95820-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-6637
Provider Business Practice Location Address Fax Number:
916-734-4150
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
C
Authorized Official Title or Position:
C.H.P. ASSISTANT CHIEF
Authorized Official Telephone Number:
916-734-6637

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CR0028 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CN4844 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR002104M , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE7275 . 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".
  • Identifier: CI4127 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DA4168 . 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: GPS000040 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZP5701Z . This is a "MEDICAID/CHDP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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