1417993452 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO

Table of content: (NPI 1417993452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417993452 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
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:
1417993452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-974-9766
Provider Business Mailing Address Fax Number:
858-974-9756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25150 HANCOCK AVE
Provider Second Line Business Practice Location Address:
SUITE# 210
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-5987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-461-6988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CHIEF, DIVISION OF NEUROSURGERY
Authorized Official Telephone Number:
619-543-5540

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , 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: GR0057991 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com