Healthcare Provider Details

I. General information

NPI: 1457344475
Provider Name (Legal Business Name): REGENTS OF THE UNIV OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

4900 BROADWAY STE 2600
SACRAMENTO CA
95820-1532
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3179
  • Fax: 916-456-2236
Mailing address:
  • Phone: 916-734-9200
  • Fax: 916-734-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES D KIRK
Title or Position: CMO
Credential: MD
Phone: 916-734-1166