Basic Information
| Provider Information | |||||||||
| NPI: | 1770042129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGENTS OF THE UNIVERSITY OF CALIFORNIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE NO 57326 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582496748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9400 CAMPUS POINT DR | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920931350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009268273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2019 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | DONALDSON | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6195436613 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UCSD MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.