Healthcare Provider Details

I. General information

NPI: 1659419638
Provider Name (Legal Business Name): REGENTS OF UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST
FRESNO CA
93701-2302
US

IV. Provider business mailing address

155 N FRESNO ST
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6400
  • Fax: 559-499-6411
Mailing address:
  • Phone: 559-499-6400
  • Fax: 559-499-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PETERSON
Title or Position: ASSOCIATE DEAN
Credential: MD
Phone: 559-499-6400