Healthcare Provider Details

I. General information

NPI: 1326031345
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

4900 BROADWAY SUITE 2600
SACRAMENTO CA
95820-1532
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7313
  • Fax: 916-734-2919
Mailing address:
  • Phone: 916-734-9200
  • Fax: 916-734-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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