Provider Demographics
NPI:1386895068
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, GOVERNMENT 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:916-734-9112
Mailing Address - Street 1:10545 ARMSTRONG AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-4101
Mailing Address - Country:US
Mailing Address - Phone:916-734-9112
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:3146 TUPPER HALL
Practice Address - Street 2:TUPPER HALL, HEALTH SCIENCES DRIVE
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-752-1757
Practice Address - Fax:530-752-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB64125FMedicaid