Healthcare Provider Details

I. General information

NPI: 1114180635
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 BUSINESS DR
SACRAMENTO CA
95820-2165
US

IV. Provider business mailing address

3671 BUSINESS DR
SACRAMENTO CA
95820-2165
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6637
  • Fax: 916-734-4150
Mailing address:
  • Phone: 916-734-6637
  • Fax: 916-734-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC C VARGAS
Title or Position: C.H.P. ASSISTANT CHIEF
Credential:
Phone: 916-734-6637