Healthcare Provider Details

I. General information

NPI: 1346208162
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 CROWN VALLEY PKWY
MISSION VIEJO CA
92691-6364
US

IV. Provider business mailing address

PO BOX 513228
LOS ANGELES CA
90051-3228
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-3905
  • Fax: 714-456-2338
Mailing address:
  • Phone: 714-456-3905
  • Fax: 714-456-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY SKINNER
Title or Position: DEPT CHAIR
Credential: MD
Phone: 714-456-3905