Provider Demographics
NPI:1194705731
Name:REGENTS OF THE UNIVERSITY OF CA
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLAPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-8203
Mailing Address - Street 1:4900 BROADWAY
Mailing Address - Street 2:STE 1200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1532
Mailing Address - Country:US
Mailing Address - Phone:916-734-9654
Mailing Address - Fax:916-736-1419
Practice Address - Street 1:10044 WOLF RD
Practice Address - Street 2:#A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-8193
Practice Address - Country:US
Practice Address - Phone:530-268-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063928Medicaid
CAZZZ00673ZMedicare ID - Type Unspecified