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	2080P0210X	Pediatric Nephrology Physician

Medicare Identifiers

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

Other Identifiers

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

General Provider Information

NPI Number	:	1801889829
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	:	2521 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2207
Country	:	US
Telephone Number	:	916-734-3179
Fax Number	:	916-456-2236

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

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1356334452 — REGENTS OF THE UNIVERSITY OF CA
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Directions to “REGENTS OF THE UNIV OF CA ” Practice Location

Language	Start Address	Practice Location

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