Provider Demographics
NPI:1548419526
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCSD RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF BUS DEV & ADMIN OFC
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:SANDACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-246-6050
Mailing Address - Street 1:PO BOX 30590
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90030-0590
Mailing Address - Country:US
Mailing Address - Phone:858-246-0500
Mailing Address - Fax:858-246-0501
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:858-246-0500
Practice Address - Fax:858-246-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548419526Medicaid
CA1548419526Medicaid