MEDICARE: REGENTS OF THE UNIV OF CA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI4127	OTHER	CA	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043208945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF THE UNIV OF CA

Provider Business Mailing Address
First Line	:	10850 WHITE ROCK RD
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6044
Country	:	US
Telephone Number	:	916-734-9200
Fax Number	:	916-734-9336

Provider Business Practice Location Address
First Line	:	3301 C ST STE 1413
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3300
Country	:	US
Telephone Number	:	916-734-6373
Fax Number	:	916-734-6793

Authorized Official
Title or Position	:	VICE PRESIDENT, GOV'T REIMBURSEMENT
Name	:	TAMMY TROVATTEN
Credential	:
Telephone Number	:	916-855-2315

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	05/16/2025

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Directions to “REGENTS OF THE UNIV OF CA ” Practice Location

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