1518300532 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

Table of content: (NPI 1518300532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518300532 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:
1518300532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DR
Provider Second Line Business Mailing Address:
MAIL CODE 8765
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-8765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-6194
Provider Business Mailing Address Fax Number:
619-543-5829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 GARDEN VIEW RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-536-7686
Provider Business Practice Location Address Fax Number:
760-536-7685
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SPANGENBERG
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR UCSD AMCARE PHARMACY
Authorized Official Telephone Number:
619-543-6194

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  51286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 51286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 51286 , 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: 1518300532 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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