=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700804200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2315 STOCKTON BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-9200
-----------------------------------------------------
Fax | 916-734-9661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10850 WHITE ROCK RD
-----------------------------------------------------
City | RANCHO CORDOVA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-6044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-9200
-----------------------------------------------------
Fax | 916-734-9661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, GOV'T REIMBURSEMENT
-----------------------------------------------------
Name | TAMMY TROVATTEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-855-2315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number | 030000086
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------