Healthcare Provider Details

I. General information

NPI: 1770979171
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY STE E24
VALENCIA CA
91355-4457
US

IV. Provider business mailing address

5767 W CENTURY BLVD 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-284-3100
  • Fax: 661-290-3310
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE A HALE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 310-301-5311