MEDICARE: REGENTS OF THE UNIV OF CA

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CR0028	OTHER	CA	RAILROAD MEDICARE PIN
2	CN4400	OTHER	CA	RAILROAD MEDICARE PIN
3	CN4844	OTHER	CA	RAILROAD MEDICARE PIN
4	DA4168	OTHER	CA	RAILROAD MEDICARE PIN
7	CI4127	OTHER	CA	RAILROAD MEDICARE PIN
8	DE7275	OTHER	CA	RAILROAD MEDICARE PIN

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

NPI Number	:	1437142452
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	:	916-734-9661

Provider Business Practice Location Address
First Line	:	4860 Y ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2307
Country	:	US
Telephone Number	:	916-734-8046
Fax Number	:	916-734-5495

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/16/2025

4860 Y ST STE 3700
SACRAMENTO, CA
95817-2307

Practice Phone: 916-734-3588
Practice Fax: