MEDICARE: REGENTS OF THE UNIVERSITY OF CA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI4127	OTHER	CA	RAILROAD MEDICARE PIN
2	CR0028	OTHER	CA	RAILROAD MEDICARE PIN
3	DE7275	OTHER	CA	RAILROAD MEDICARE PIN
5	CN4400	OTHER	CA	RAILROAD MEDICARE PIN
7	CN4844	OTHER	CA	RAILROAD MEDICARE PIN
8	DA4168	OTHER	CA	RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235122250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF THE UNIVERSITY OF CA

Provider Business Mailing Address
First Line	:	10850 WHITE ROCK RD
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6044
Country	:	US
Telephone Number	:	916-734-9200
Fax Number	:	916-734-9661

Provider Business Practice Location Address
First Line	:	4501 X ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	916-734-8252
Fax Number	:	916-454-4614

Authorized Official
Title or Position	:	VICE PRESIDENT, GOV'T REIMBURSEMENT
Name	:	TAMMY TROVATTEN
Credential	:
Telephone Number	:	916-855-2315

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/16/2025

Similar Medicare Providers

1790919512 — DR. RASHMI VERMA M.D.
Practice Location Address:

4501 X STREET , UC DAVIS CANCER CENTER
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-3772
Practice Fax: 916-734-7953

1467459222 — MEHRAD ABEDI M.D.
Practice Location Address:

4501 X ST STE 3016
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-5981
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1801889068 — REGENTS OF THE UNIV OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-5803
Practice Fax: 916-731-5706

1629061643 — REGENTS OF THE UNIVERSITY OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

Practice Phone: 916-724-5803
Practice Fax: 916-734-7946

1750374815 — REGENTS OF THE UNIV OF CA
Practice Location Address:

4501 X ST
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-6930
Practice Fax: 916-734-6666

1972585743 — DR. PRIMO NERY LARA JR. M.D.
Practice Location Address:

2279 45TH STREET
SACRAMENTO, CA
95817-2229

Practice Phone: 916-734-5959
Practice Fax: 916-703-5265

Directions to “REGENTS OF THE UNIVERSITY OF CA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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