Provider Demographics
NPI:1417050956
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 & OPERATIONS
Authorized Official - Prefix:
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
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
364823305OtherUS DEPT OF LABOR
364823306OtherUS DEPT OF LABOR
364823310OtherUS DEPT OF LABOR
CACGP016905OtherGHPP
364823307OtherUS DEPT OF LABOR
CAZZZ26235ZOtherBLUE SHIELD GRP #
CA13933OtherCMS
364823300OtherUS DEPT OF LABOR
364823301OtherUS DEPT OF LABOR
364823302OtherUS DEPT OF LABOR
364823303OtherUS DEPT OF LABOR
364823304OtherUS DEPT OF LABOR
CAGR0013571OtherCALOPTIMA
364823308OtherUS DEPT OF LABOR
CA72OtherRYAN WHITE
CACQ4024OtherRAILROAD MEDICARE
CAGR0013571Medicaid