Healthcare Provider Details

I. General information

NPI: 1053304071
Provider Name (Legal Business Name): REGENTS OF THE UNIV OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 TUPPER HALL
DAVIS CA
95616
US

IV. Provider business mailing address

10850 WHITE ROCK RD
RANCHO CORDOVA CA
95670-6044
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-9402
  • Fax:
Mailing address:
  • Phone: 916-734-9200
  • Fax: 916-734-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY TROVATTEN
Title or Position: VICE PRESIDENT, GOV'T REIMBURSEMENT
Credential:
Phone: 916-855-2315