Provider Demographics
NPI:1609134360
Name:REGENTS OF THE UNIV OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-9308
Mailing Address - Street 1:1250 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:424-259-8365
Mailing Address - Fax:424-259-6626
Practice Address - Street 1:1250 16TH STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT - 1ST FL G543
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1101
Practice Address - Country:US
Practice Address - Phone:424-259-8405
Practice Address - Fax:424-259-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000146332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-0112Medicare PIN