Provider Demographics
NPI:1043208945
Name:REGENTS OF THE UNIV OF CA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:UCD DERMATOPATHOLOGY LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-833-4206
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:916-734-9336
Practice Address - Street 1:3301 C ST STE 1413
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3300
Practice Address - Country:US
Practice Address - Phone:916-734-6373
Practice Address - Fax:916-734-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI4127OtherRAILROAD MEDICARE PIN
CALAB95787FMedicaid
CALAB95787FMedicaid