Healthcare Provider Details

I. General information

NPI: 1013035716
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST STREET STE 350
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE 200
SAN DIEGO CA
92123-4800
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-4800
  • Fax: 858-496-4850
Mailing address:
  • Phone: 858-502-1135
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETTEN DRAKE PICKERING
Title or Position: DIVISION CHIEF OF GENERAL ACADEMIC
Credential: M.D.
Phone: 858-496-4827