Provider Demographics
NPI:1225380827
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
Other - Org Name:GIFFORD CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-543-6250
Mailing Address - Street 1:140 ARBOR DR
Mailing Address - Street 2:MC 0851
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2007
Mailing Address - Country:US
Mailing Address - Phone:619-543-7795
Mailing Address - Fax:619-543-7013
Practice Address - Street 1:140 ARBOR DR
Practice Address - Street 2:MC 0851
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2007
Practice Address - Country:US
Practice Address - Phone:619-543-7795
Practice Address - Fax:619-543-7013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty