Healthcare Provider Details

I. General information

NPI: 1447051370
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 1ST AVE RM 1-601
SAN DIEGO CA
92103
US

IV. Provider business mailing address

PO BOX 743475
LOS ANGELES CA
90074-3475
US

V. Phone/Fax

Practice location:
  • Phone: 619-471-0230
  • Fax: 619-543-7791
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRACEY JANE SPANGENBERG
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 619-543-6194