Healthcare Provider Details

I. General information

NPI: 1093795643
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 1700
SACRAMENTO CA
95817
US

IV. Provider business mailing address

4900 BROADWAY STE 1200
SACRAMENTO CA
95820-1532
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6039
  • Fax:
Mailing address:
  • Phone: 916-734-9654
  • Fax: 916-736-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT J SLAPNIK
Title or Position: CFO
Credential: MD
Phone: 916-734-8203