Provider Demographics
NPI:1093795643
Name:REGENTS OF THE UNIVERSITY OF CA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CA
Other - Org Name:REGENTS UCDMG PCN ACC ORTHO CLINIC
Other - Org Type:Other Name
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 1:4860 Y ST
Practice Address - Street 2:STE 1700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-6039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001376Medicaid
CAGRE001376Medicaid