Healthcare Provider Details

I. General information

NPI: 1336171818
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE SUITE 650
ORANGE CA
92868
US

IV. Provider business mailing address

POB 31001-2482
PASADENA CA
91110-2482
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-3228
  • Fax: 714-456-2229
Mailing address:
  • Phone: 714-456-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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