MEDICARE: UC REGENTS

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	207RH0003X	Hematology & Oncology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CU0494	OTHER	CA	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZP3010Z	OTHER	CA	MEDI-CAL GROUP #
2	ZZZ53996Z	OTHER	CA	BLUE SHIELD GROUP #

General Provider Information

NPI Number	:	1356399380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UC REGENTS

Provider Business Mailing Address
First Line	:	PO BOX 54509
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90054-0509
Country	:	US
Telephone Number	:	714-456-8068
Fax Number	:	714-456-3765

Provider Business Practice Location Address
First Line	:	101 THE CITY DR S
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868
Country	:	US
Telephone Number	:	714-456-8068
Fax Number	:	714-456-3765

Authorized Official
Title or Position	:	UPS PROVIDER RELATIONS
Name	:	DR. UCI HEALTH PROVIDER RELATIONS
Credential	:
Telephone Number	:	714-456-2986

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/17/2018

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Directions to “UC REGENTS ” Practice Location

Language	Start Address	Practice Location

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