1710918545 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

Table of content: (NPI 1710918545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710918545 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:
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1710918545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10850 WHITE ROCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-6044
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:
2315 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:
95817-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-9200
Provider Business Practice Location Address Fax Number:
916-734-9661
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SADRO
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-703-5009

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  030000086 , 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: ZZR00599W . This is a "DEPT OF HEALTH SVCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC00599W , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40599W , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSX00599G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA3407Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSD00599G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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