Provider Demographics
NPI:1053304113
Name:REGENTS OF THE UNIV OF CA
Entity type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, GOV'T REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROVATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-855-2315
Mailing Address - Street 1:10850 WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6044
Mailing Address - Country:US
Mailing Address - Phone:916-734-9200
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-1986
Practice Address - Fax:916-734-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGNP000070Medicaid
CACN4400OtherRAILROAD MEDICARE PIN
CAGR0021041Medicaid
CACI4127OtherRAILROAD MEDICARE PIN
CADA4168OtherRAILROAD MEDICARE PIN
CACN4844OtherRAILROAD MEDICARE PIN
CADE7275OtherRAILROAD MEDICARE PIN
CACR0028OtherRAILROAD MEDICARE PIN
CAZZZ13608ZMedicare PIN
CACN4400OtherRAILROAD MEDICARE PIN