Healthcare Provider Details

I. General information

NPI: 1780910471
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 UNIVERSITY CENTER LANE SUITE 201
SAN DIEGO CA
92122
US

IV. Provider business mailing address

9500 GILMAN DRIVE MC0878
SAN DIEGO CA
92093-0878
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-6028
  • Fax: 858-550-9032
Mailing address:
  • Phone: 858-657-6028
  • Fax: 858-550-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LORI DONALDSON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 619-543-6613