1174758650 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174758650 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:
1174758650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
D440 MED SCI 1 ZOT 4800
Provider Second Line Business Mailing Address:
UNIVERSITY OF CALIFORNIA
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92697-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-824-7071
Provider Business Mailing Address Fax Number:
949-824-2160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DR S BLDG 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-5889
Provider Business Practice Location Address Fax Number:
714-456-3964
Provider Enumeration Date:
05/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
714-456-6936

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 11748 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05D1002946 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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