Healthcare Provider Details

I. General information

NPI: 1275643694
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE STE 650
ORANGE CA
92868-3224
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 650
ORANGE CA
92868-3224
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-3077
  • Fax: 714-456-2229
Mailing address:
  • Phone: 714-456-3077
  • Fax: 714-456-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA HAYES-SWARTZ
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 714-456-3228