Provider Demographics
NPI:1396010609
Name:REGENTS OF THE UNIV OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHARMACEUTICAL SERV
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-8500
Mailing Address - Street 1:1223 16TH ST RM 1202
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1217
Mailing Address - Country:US
Mailing Address - Phone:424-259-8520
Mailing Address - Fax:424-259-8524
Practice Address - Street 1:1223 16TH ST RM 1202
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1217
Practice Address - Country:US
Practice Address - Phone:424-259-8520
Practice Address - Fax:424-259-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA508973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134261OtherPK
CA1396010609Medicaid