1831208826 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831208826 NPI number — REGENTS OF THE UNIVERSITY OF CALIFORNIA

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 Other Organization Name:

UCSD MEDICAL GROUP

Provider Other Organization Name Type Code:

5

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:

1831208826

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/01/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 232410

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN DIEGO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

92193-2410

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

200 W ARBOR DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAN DIEGO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

92103-9000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

800-926-8273

Provider Business Practice Location Address Fax Number:

888-539-8781

Provider Enumeration Date:

08/30/2006

Authorized Official Last Name:

PRICE

Authorized Official First Name:

DENNIS

Authorized Official Middle Name:

Authorized Official Title or Position:

EXECUTIVE DIRECTOR

Authorized Official Telephone Number:

858-249-6752

• Taxonomy code: 207ZB0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZC0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZF0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZH0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZI0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZM0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZN0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207ZP0104X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0213X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 364823305 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: ZZZ26234Z . This is a "BLUE SHIELD GRP" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823304 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: CGP016905 . This is a "GHPP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 364823301 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823306 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 72 . This is a "RYAN WHITE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GR0013570 . This is a "CALOPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: GR0013570 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 364823307 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823308 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 13933 . This is a "CMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 364823302 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823303 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823310 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 364823300 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: CQ4024 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".