Provider Demographics
NPI:1174662555
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UC IRVINE PATHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UPS PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:UCI HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVIDER RELATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-2968
Mailing Address - Street 1:PO BOX 31001-2482
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2482
Mailing Address - Country:US
Mailing Address - Phone:714-456-8835
Mailing Address - Fax:714-456-6248
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-6411
Practice Address - Fax:714-456-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0579200OtherMEDICARE PTAN
CAZZZP3016ZOtherBLUE SHIELD
CALAB00975FMedicaid