Provider Demographics
NPI:1356444897
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
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:800-926-8273
Practice Address - Fax:888-539-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA364823306OtherUS DEPT OF LABOR
CA364823310OtherUS DEPT OF LABOR GRP
CAGR0013560Medicaid
CA364823307OtherUS DEPT OF LABOR GRP NO
CAGR0013560OtherCALOPTIMA
CA364823301OtherUS DEPARTEMENT OF LABOR
CA364823303OtherUS DEPT OF LABOR
CA364823308OtherUS DEPT OF LABOR
CACGP016905OtherGHPP GRP NO
CA364823302OtherUS DEPT OF LABOR
CACQ4024OtherRAILROAD MEDICARE
CAZZZ25751ZOtherBLUE SHIELD GROUP NO
CA364823300OtherUS DEPT OF LABOR
CA364823304OtherUS DEPT OF LABOR
CA2327OtherCMS GRP NO.
CA364823305OtherUS DEPT OF LABOR
CA364823303OtherUS DEPT OF LABOR