Provider Demographics
NPI:1952322935
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCSD MOORES CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR UCSD AMCARE PHARM
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-543-6194
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE 8765
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8765
Mailing Address - Country:US
Mailing Address - Phone:619-543-6194
Mailing Address - Fax:619-543-5829
Practice Address - Street 1:3855 HEALTH SCIENCES DR
Practice Address - Street 2:# 0845
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0845
Practice Address - Country:US
Practice Address - Phone:858-822-6088
Practice Address - Fax:858-822-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE46932333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5615488OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHB469320Medicaid
CAPHB469320Medicaid