Provider Demographics
NPI:1487602546
Name:REGENTS OF THE UNIVERSITY OF
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-6227
Mailing Address - Street 1:PO BOX 54330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0330
Mailing Address - Country:US
Mailing Address - Phone:714-456-8068
Mailing Address - Fax:714-456-3765
Practice Address - Street 1:101 THE CITY DR SOUTH
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-8068
Practice Address - Fax:714-456-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT0508OtherRAILROAD GROUP
CAGR0013290OtherMEDI-CAL GROUP
CAZZZP3013ZOtherBLUE SHIELD GROUP #
CACT0508OtherRAILROAD GROUP