Healthcare Provider Details

I. General information

NPI: 1174758650
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 23
ORANGE CA
92868-3201
US

IV. Provider business mailing address

D440 MED SCI 1 ZOT 4800 UNIVERSITY OF CALIFORNIA
IRVINE CA
92697-0001
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5889
  • Fax: 714-456-3964
Mailing address:
  • Phone: 949-824-7071
  • Fax: 949-824-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF 11748
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD S NEWMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-456-6936