Provider Demographics
NPI: | 1508968967 |
---|---|
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: | MR |
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: | FILE 57326 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90074-2410 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-926-8273 |
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: | 2006-09-05 |
Last Update Date: | 2024-04-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103G00000X, 103T00000X, 103TC2200X, 103TP2701X, 106H00000X, 174400000X, 2084P0800X, 2084P0802X, 2084P0804X, 2084P0805X | ||
CA | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CQ4024 | Other | RAILROAD MEDICARE | |
364823305 | Other | US DEPT OF LABOR | |
CA | ZZZP3711Z | Medicaid | |
364823307 | Other | US DEPT OF LABOR | |
364823310 | Other | US DEPT OF LABOR | |
364823300 | Other | US DEPT OF LABOR | |
364823303 | Other | US DEPT OF LABOR | |
364823304 | Other | US DEPT OF LABOR | |
CA | GPS000030 | Medicaid | |
364823301 | Other | US DEPT OF LABOR | |
364823306 | Other | US DEPT OF LABOR | |
364823308 | Other | US DEPT OF LABOR | |
CA | ZZZ73229Z | Other | BLUE SHIELD |
364823302 | Other | US DEPT OF LABOR | |
CA | CGP016905 | Other | GHPP |
CA | ZZZ73229Z | Other | BLUE SHIELD |
CA | ZZZP3711Z | Medicaid |