Healthcare Provider Details

I. General information

NPI: 1316968399
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 FRONT ST RM 1-127
SAN DIEGO CA
92103-2030
US

IV. Provider business mailing address

PO BOX 743475
LOS ANGELES CA
90074-3475
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5934
  • Fax: 619-543-6784
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHE37895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHE37895
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHE37895
License Number StateCA

VIII. Authorized Official

Name: TRACEY SPANGENBERG
Title or Position: DIRECTOR, AMCARE PHARMACY SERVICES
Credential:
Phone: 858-249-4821