Provider Demographics
NPI:1063401826
Name:REGENTS OF THE UNIV OF CA
Entity type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, GOV'T REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROVATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-855-2315
Mailing Address - Street 1:10850 WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6044
Mailing Address - Country:US
Mailing Address - Phone:916-734-9200
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-8046
Practice Address - Fax:916-734-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002104VMedicaid
CADE7275OtherRAILROAD MEDICARE PIN
CAGNP000070Medicaid
CACI4127OtherRAILROAD MEDICARE PIN
CACN4400OtherRAILROAD MEDICARE PIN
CACN4844OtherRAILROAD MEDICARE PIN
CACR0028OtherRAILROAD MEDICARE PIN
CADA4168OtherRAILROAD MEDICARE PIN
CAZZZP3438ZMedicare PIN