Provider Demographics
NPI:1417993452
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO
Other - Org Name:UCSD NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, DIVISION OF NEUROSURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-543-5540
Mailing Address - Street 1:PO BOX 51013
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5313
Mailing Address - Country:US
Mailing Address - Phone:858-974-9766
Mailing Address - Fax:858-974-9756
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE# 210
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-461-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057991Medicaid
CAGR0057991Medicaid