Healthcare Provider Details

I. General information

NPI: 1912987553
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W COVELL BLVD
DAVIS CA
95616-5645
US

IV. Provider business mailing address

10850 WHITE ROCK RD
RANCHO CORDOVA CA
95670-6044
US

V. Phone/Fax

Practice location:
  • Phone: 530-747-3000
  • Fax:
Mailing address:
  • Phone: 916-734-9255
  • Fax: 916-451-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLEN D HALL
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 916-734-8203