Provider Demographics
NPI:1356510556
Name:REGENTS OF THE UNIVERSITY OF CALIFNORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFNORNIA
Other - Org Name:AESTHETIC AND PLASTIC SURGERY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DIVISION OF PLASTIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-3228
Mailing Address - Street 1:200 S MANCHESTER AVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3217
Mailing Address - Country:US
Mailing Address - Phone:714-456-3228
Mailing Address - Fax:714-456-2229
Practice Address - Street 1:200 S MANCHESTER AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3217
Practice Address - Country:US
Practice Address - Phone:714-456-3228
Practice Address - Fax:714-456-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherBLUE CROSS