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General NPI Number Information
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NPI Number | 1073108809
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3636 GATEWAY CENTER AVE STE 102
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City | SAN DIEGO
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State | CA
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Zip | 92102-4524
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Country | US
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Telephone | 858-249-6455
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Fax | 858-732-0870
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Provider Business Mailing Address
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Address Line | FILE 556631
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LORI R DONALDSON
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Credential |
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Telephone | 619-543-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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