Provider Demographics
NPI:1932264413
Name:UNIVERSITY OF CALIFORNIA REGENTS
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA REGENTS
Other - Org Name:UCSD BIOCHEMICAL GENETICS LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:619-543-5260
Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:MAIL CODE 0830
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0830
Mailing Address - Country:US
Mailing Address - Phone:619-543-5260
Mailing Address - Fax:619-543-3565
Practice Address - Street 1:220 DICKINSON ST
Practice Address - Street 2:ROOM 203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-543-5260
Practice Address - Fax:619-543-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF4102291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB04102FMedicaid