Healthcare Provider Details

I. General information

NPI: 1487602546
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR SOUTH
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 54330
LOS ANGELES CA
90054-0330
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8068
  • Fax: 714-456-3765
Mailing address:
  • Phone: 714-456-8068
  • Fax: 714-456-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA COPEN
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 714-456-6227