Healthcare Provider Details

I. General information

NPI: 1275526329
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TB 156
DAVIS CA
95616
US

IV. Provider business mailing address

4900 BROADWAY STE 2500
SACRAMENTO CA
95820-1532
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2714
  • Fax:
Mailing address:
  • Phone: 916-734-9200
  • Fax: 916-734-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM H MCGOWAN
Title or Position: CFO
Credential:
Phone: 916-734-9129