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	207VX0201X	Gynecologic Oncology Physician

Medicare Identifiers

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

Other Identifiers

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

General Provider Information

NPI Number	:	1750374815
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	:	4501 X ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	916-734-6930
Fax Number	:	916-734-6666

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

Similar Medicare Providers

1467459222 — MEHRAD ABEDI M.D.
Practice Location Address:

4501 X ST STE 3016
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-5981
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1801889068 — REGENTS OF THE UNIV OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

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1629061643 — REGENTS OF THE UNIVERSITY OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

Practice Phone: 916-724-5803
Practice Fax: 916-734-7946

1235122250 — REGENTS OF THE UNIVERSITY OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-8252
Practice Fax: 916-454-4614

1972585743 — DR. PRIMO NERY LARA JR. M.D.
Practice Location Address:

2279 45TH STREET
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95817-2229

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1932181609 — DR. THEODORE WUN M.D.
Practice Location Address:

2279 45TH STREET
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95817-2229

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

Language	Start Address	Practice Location

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