MEDICARE: REGENTS OF THE UNIVERSITY 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	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1245210889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF THE UNIVERSITY OF CA

Provider Business Mailing Address
First Line	:	4900 BROADWAY
Second Line	:	SUITE 1200
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-1532
Country	:	US
Telephone Number	:	916-734-9654
Fax Number	:	916-736-1419

Provider Business Practice Location Address
First Line	:	151 E WEBSTER ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2949
Country	:	US
Telephone Number	:	530-458-4250
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KURT J SLAPNIK
Credential	:	M.D.
Telephone Number	:	916-734-8203

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	06/05/2009

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1235155318 — DR. ETHELWOLDO PASCUAL GUERRERO MD
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Directions to “REGENTS OF THE UNIVERSITY OF CA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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