Provider Demographics
NPI:1003934803
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCSD MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE & OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-249-6752
Mailing Address - Street 1:FILE 57326
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2410
Mailing Address - Country:US
Mailing Address - Phone:800-926-8273
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:888-926-8273
Practice Address - Fax:888-539-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09218ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0013562Medicaid
CAZZZP3708ZMedicaid
CACQ4024OtherRAILORAD MEDCIARE
CAZZZP3708ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ69123ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ09217ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZP3722ZOtherBLUE SHIELD OF CALIFORNIA
CACQ4024OtherRAILORAD MEDCIARE