Provider Demographics
NPI:1386637346
Name:REGENTS OF THE UNIVERSITY OF CA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CA
Other - Org Name:REGENTS UCDPBG PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-703-5009
Mailing Address - Street 1:10850 WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6044
Mailing Address - Country:US
Mailing Address - Phone:916-734-9200
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-3179
Practice Address - Fax:916-456-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR0028OtherRAILROAD MEDICARE PIN
CADA4168OtherRAILROAD MEDICARE PIN
CAZZZP5701ZOtherMEDICAID/CHDP PIN
CADE7275OtherRAILROAD MEDICARE PIN
CAGR002104MMedicaid
CACN4400OtherRAILROAD MEDICARE PIN
CACI4127OtherRAILROAD MEDICARE PIN
CACN4844OtherRAILROAD MEDICARE PIN
CAGPS000040Medicaid
CAGNP000070Medicaid
CACN4400OtherRAILROAD MEDICARE PIN