Provider Demographics
NPI:1548426687
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCSD CHILDREN/ADOLESCENT PSYCHIATRY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-543-6060
Mailing Address - Street 1:FILE 55663
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5663
Mailing Address - Country:US
Mailing Address - Phone:619-543-6308
Mailing Address - Fax:619-543-3004
Practice Address - Street 1:6535 ALVARADO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5002
Practice Address - Country:US
Practice Address - Phone:619-543-6308
Practice Address - Fax:619-543-3004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UDSD MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-29
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000101273R00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM30025FMedicaid
CA05S205Medicare Oscar/Certification