Healthcare Provider Details

I. General information

NPI: 1558311811
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 513377
LOS ANGELES CA
90051-3377
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6411
  • Fax: 714-456-5873
Mailing address:
  • Phone: 714-456-8835
  • Fax: 714-456-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

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