Healthcare Provider Details

I. General information

NPI: 1528362571
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GARDEN VIEW RD STE 200
ENCINITAS CA
92024-2475
US

IV. Provider business mailing address

1200 GARDEN VIEW RD STE 200
ENCINITAS CA
92024-2475
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5733
  • Fax: 619-543-3183
Mailing address:
  • Phone: 619-543-1899
  • Fax: 619-543-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DENNIS PRICE
Title or Position: DIRECTOR, REVENUE & OPERATIONS
Credential:
Phone: 858-249-6752