Provider Demographics
NPI:1760594998
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:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE & OPERATION
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:2006-09-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
364823300OtherUS DEPT OF LABOR
364823301OtherUS DEPT OF LABOR
364823303OtherUS DEPT OF LABOR
CACGP016905OtherGHPP
CQ4024OtherRAILROAD MEDICARE
CA2327OtherCMS
364823307OtherUS DEPT OF LABOR
CAZZZ26553ZOtherBLUE SHIELD OF CALIFORNIA
364823302OtherUS DEPT OF LABOR
364823305OtherUS DEPT OF LABOR
364823306OtherUS DEPT OF LABOR
364823308OtherUS DEPT OF LABOR
364823310OtherUS DEPT OF LABOR
CAZZZP3713ZMedicaid
364823308OtherUS DEPT OF LABOR
CAZZZP3713ZMedicaid