Healthcare Provider Details

I. General information

NPI: 1386895068
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 TUPPER HALL TUPPER HALL, HEALTH SCIENCES DRIVE
DAVIS CA
95616
US

IV. Provider business mailing address

10545 ARMSTRONG AVE STE 1200
MATHER CA
95655-4101
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-1757
  • Fax: 530-752-8692
Mailing address:
  • Phone: 916-734-9112
  • Fax: 916-734-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAMMY TROVATTEN
Title or Position: DIRECTOR, GOVERNMENT REIMBURSEMENT
Credential:
Phone: 916-734-9112