Healthcare Provider Details

I. General information

NPI: 1225767247
Provider Name (Legal Business Name): THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 WESTWOOD PLAZA ROOM A8-216
LOS ANGELES CA
90095-1759
US

IV. Provider business mailing address

740 WESTWOOD PLZ RM A8-216
LOS ANGELES CA
90095-1759
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JEFFREY
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 310-825-5263