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NPI Code Detail

MEDICARE: REGENTS OF THE UNVIERSITY OF CALIFONRIA - UCSD MEDICAL GROUP

MEDICARE: REGENTS OF THE UNVIERSITY OF CALIFONRIA - UCSD MEDICAL GROUP
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
1103G00000XClinical Neuropsychologist
2103TB0200XCognitive & Behavioral Psychologist
3103TC0700XClinical Psychologist
4103TC2200XClinical Child & Adolescent Psychologist
5103T00000XPsychologist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6CQ4024OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ73229ZOTHERCABLUE SHIELD
2364823303OTHERUS DEPT OF LABOR
3364823300OTHERUS DEPT OF LABOR
4364823304OTHERUS DEPT OF LABOR
5364823308OTHERUS DEPT OF LABOR
7364823305OTHERUS DEPT OF LABOR
8364823310OTHERUS DEPT OF LABOR
9CGP016905OTHERCAGHPP
10364823301OTHERUS DEPT OF LABOR
11364823307OTHERUS DEPT OF LABOR
12MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13364823302OTHERUS DEPT OF LABOR
14364823306OTHERUS DEPT OF LABOR
15ZZZP3711ZOTHERCABLUE SHIELD

General Provider Information

NPI Number : 1417059874
Entity Type Code : Organization
Provider Name (Legal Business Name) : REGENTS OF THE UNVIERSITY OF CALIFONRIA - UCSD MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 232410
Second Line :
City : SAN DIEGO
State : CA
Zip : 92193-2410
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 W ARBOR DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-9000
Country : US
Telephone Number : 800-926-8273
Fax Number : 888-539-8781
Authorized Official
Title or Position : DIRECTOR,REVENUE CYCLE & OPERATIONS
Name : MR. MICHAEL DENNIS PRICE
Credential :
Telephone Number : 858-249-6752
Provider Enumeration Date : 09/05/2006
Last Update Date : 02/09/2022

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