Provider Demographics
NPI:1174758650
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-6936
Mailing Address - Street 1:D440 MED SCI 1 ZOT 4800
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-0001
Mailing Address - Country:US
Mailing Address - Phone:949-824-7071
Mailing Address - Fax:949-824-2160
Practice Address - Street 1:101 THE CITY DR S BLDG 23
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5889
Practice Address - Fax:714-456-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11748291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1002946OtherCLIA
CA05D1002946OtherCLIA