Healthcare Provider Details

I. General information

NPI: 1811255060
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

IV. Provider business mailing address

PO BOX 741696
LOS ANGELES CA
90074-1696
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax:
Mailing address:
  • Phone: 866-819-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN FERENCIK
Title or Position: DIRECTOR, PHYSICIAN RELATIONS
Credential:
Phone: 951-827-7793