MEDICARE: REGENTS OF THE UNIVERSITY OF CALIFORNIA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1376920777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS OF THE UNIVERSITY OF CALIFORNIA

Provider Business Mailing Address
First Line	:	1111 FRANKLIN ST
Second Line	:	11TH FLOOR
City	:	OAKLAND
State	:	CA
Zip	:	94607-5201
Country	:	US
Telephone Number	:	510-987-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 FRANKLIN ST
Second Line	:	11TH FLOOR
City	:	OAKLAND
State	:	CA
Zip	:	94607-5201
Country	:	US
Telephone Number	:	510-987-9510
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KARYN DIGIORGIO
Credential	:	MSN, RN
Telephone Number	:	510-987-9570

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/05/2015

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

Language	Start Address	Practice Location

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