Provider Demographics
NPI:1801103619
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROF PSYCHIATRY AND BEHAVIORAL SCIE
Authorized Official - Prefix:PROF
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHOPTAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-794-6206
Mailing Address - Street 1:910 VINE STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2702
Mailing Address - Country:US
Mailing Address - Phone:323-461-3106
Mailing Address - Fax:323-461-3109
Practice Address - Street 1:910 VINE STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2702
Practice Address - Country:US
Practice Address - Phone:323-461-3106
Practice Address - Fax:323-461-3109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCLA - VINE STREET CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPFY13300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty