Provider Demographics
NPI:1790741866
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCI RENAL DIALYSIS
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN, SCHOOL OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-824-5926
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-6373
Mailing Address - Country:US
Mailing Address - Phone:714-456-6238
Mailing Address - Fax:714-456-7816
Practice Address - Street 1:101 CITY DR SOUTH
Practice Address - Street 2:BLDG 52, RTE 9
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-5555
Practice Address - Fax:714-456-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC70039FMedicaid
CACDC70039FMedicaid