REGENTS OF THE UNIVERSITY OF CA (NPI# 1104815067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104815067 |
| Entity Type | Organization |
| Organization Name | REGENTS OF THE UNIVERSITY OF CA |
| Other Organization Name | REGENTS UCDPBG PED |
| Practice Address |
2521 Stockton Blvd Sacramento CA 95817-2207 |
| Mailing Address |
4900 Broadway Suite 2600 Sacramento CA 95820-1532 |
| Practice Telephone | 9167343179 |
| Practice Fax Number | 9164562236 |
| Mailing Telephone | 9167349200 |
| Mailing Fax Number | 9167349661 |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2014-03-21 |
| Authorized Official Name | MR. JAMES D KIRK (CMO) |
| Authorized Official Telephone | 9167341166 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD MEDICARE PIN | CI4127 | 01 |
| CA | RAILROAD MEDICARE PIN | CR0028 | 01 |
| CA | GRW02104J | 05 | |
| CA | GNP000070 | 05 | |
| CA | MEDICAID/CHDP PIN | ZZZP5701Z | 01 |
| Other Name | Type Code |
|---|---|
| Regents UCDPBG PED | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194705731 | Regents of The University of Ca | Clinic/Center | 10044 Wolf Rd, #a, Grass Valley, CA 95949-8193 | 2006-01-19 |
| 1245210889 | Regents of The University of Ca | Clinic/Center | 151 E Webster St, Colusa, CA 95932-2949 | 2006-01-19 |
| 1275526329 | Regents of The University of Ca | Internal Medicine | Tb 156, Davis, CA 95616 | 2005-08-24 |
| 1528051679 | Regents of The University of Ca | Internal Medicine | 1508 Alhambra Blvd, Sacramento, CA 95816-6510 | 2005-08-24 |
| 1164415238 | Regents of The University of Ca | Psychiatry & Neurology | 2230 Stockton Blvd, Sacramento, CA 95817-1419 | 2005-08-24 |
| 1770953960 | Regents of The University of Ca | Clinic/Center | 477 N El Camino Real, Suite A306, Encinitas, CA 92024-1328 | 2015-09-30 |
| 1992930986 | Regents of The University of Ca | Family Medicine | 4860 Y St, Ste 200, Sacramento, CA 95817-2307 | 2009-05-20 |
| 1396997458 | Regents of The University of Ca | Psychiatry & Neurology | 2825 50th St, Sacramento, CA 95817-2310 | 2008-10-21 |
| 1578728077 | Regents of The University of Ca | Clinic/Center | 2521 Stockton Blvd, Ste. 5200, Sacramento, CA 95817-2207 | 2008-07-23 |
| 1124008719 | Regents of The University of Ca | Clinic/Center | 2000 O St, Ste 210, Sacramento, CA 95811-5224 | 2006-01-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Vermont Business Registrations | REGENTS OF THE UNIVERSITY OF CALIFORNIA | 1111 Franklin St, Flr 10, Oakland, CA 94607 |
| System for Award Management (SAM) Entities | REGENTS OF THE UNIVERSITY OF CALIFORNIA AT RIVERSIDE | 200 Universty Office Bldg, Riverside, CA 92521-0001 |
| System for Award Management (SAM) Entities | REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE | 1855 Folsom St Ste 425, San Francisco, CA 94143-4249 |
| Street Address |
2521 STOCKTON BLVD |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95817-2207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548267867 | Robert David Lyons | Dentist | 2521 Stockton Blvd, Dental Clinic, Glassrock Building, Sacramento, CA 95817-2207 | 2005-07-01 |
| 1831798636 | Cynthia A Steele | Registered Nurse | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2020-10-22 |
| 1679118095 | Rodrigo Garcia Almirol Jr. | Registered Nurse | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2019-11-08 |
| 1487115291 | Diana Yasmin Arellano | Registered Nurse | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2019-03-26 |
| 1609335462 | Julia Grissinger | Registered Nurse | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2019-03-19 |
| 1659880177 | Nogah Hannah Nativ | Speech-Language Pathologist | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2017-09-27 |
| 1528598026 | Megan Brown | Registered Nurse | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2017-06-16 |
| 1477083533 | Jessica Pietrowski | Speech-Language Pathologist | 2521 Stockton Blvd, Sacramento, CA 95817-2207 | 2017-06-12 |
| 1952836058 | Farrukh Rasool Virani | Student in an Organized Health Care Education/Training Program | 2521 Stockton Blvd, Ste 7200, Sacramento, CA 95817-2207 | 2017-04-26 |
| 1710412036 | Lindsay Olinde | Student in an Organized Health Care Education/Training Program | 2521 Stockton Blvd, Ste. 7200, Sacramento, CA 95817-2207 | 2017-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346855103 | Quintin Kuse | Student in an Organized Health Care Education/Training Program | 4610 X Street, Sacramento, Sacramento, CA 95817 | 2020-09-09 |
| 1285259283 | Uc Davis Health | Dietitian, Registered | 2315 Stockton Blvd Sesp 0160, Sacramento, CA 95817 | 2020-06-15 |
| 1942840558 | Michael Marchand-gareau | Ophthalmology | Michael Marchand - Uc Davis Eye Center, 4860 Y Street, Suite 2400, Sacramento, CA 95817 | 2020-01-11 |
| 1467010728 | Jiunn Liang Jonathan Yap | Student in an Organized Health Care Education/Training Program | 4860 Y Str, Ste. 2820, Sacramento, CA 95817 | 2019-06-03 |
| 1083176614 | Kevin Lee | Student in an Organized Health Care Education/Training Program | 2315 Stockton Blvd, Op512, Sacramento, CA 95817 | 2019-04-02 |
| 1508326703 | Ritika Johal | Student in an Organized Health Care Education/Training Program | 4150 V Street, Pssb 1200, Sacramento, CA 95817 | 2019-03-22 |
| 1811468838 | Paige Palsgaard | Behavior Technician | 6730 4th Ave Apt 1731d, Sacramento, CA 95817 | 2018-12-17 |
| 1922503408 | Marie Rossi | Student in an Organized Health Care Education/Training Program | 4150 V Street #1100, Sacramento, CA 95817 | 2018-03-27 |
| 1639673791 | Sean Lam | Student in an Organized Health Care Education/Training Program | 4150 V Street #1200, Sacramento, CA 95817 | 2018-03-22 |
| 1124555388 | Tatyana Polyak | Surgery | 2335 Stockton Blvd., Naob 6th Floor, Sacramento, CA 95817 | 2017-05-18 |
| Find all providers in zip 95817 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396796140 | Joanne Elizabeth Natale | Pediatrics | 2561 Stockton Blvd, Uc Davis Medical Center, Department O, Sacramento, CA 95817 | 2006-05-15 |
| 1245215557 | James Paul Marcin | Pediatrics | 2954 26th St, Sacramento, CA 95818-3512 | 2005-12-08 |
| 1558353151 | Azad Sheikh | Pediatrics | 5151 F St, Sacramento, CA 95819-3223 | 2005-08-19 |
| 1871585489 | Lehman Ernest Black IIi | Pediatrics | 5151 F St 6 North, Sacramento, CA 95819-3222 | 2005-08-19 |
| 1912999525 | Daniel Augustine Falco | Pediatrics | 5151 F Street 6 North, Sacramento, CA 95819-3222 | 2005-08-19 |
| 1861806036 | Alia Rachel Broman | Pediatrics | 2516 Stockton Blvd, Sacramento, CA 95817-2208 | 2014-06-16 |
| 1215270871 | Brian David Goudy | Pediatrics | 2516 Stockton Blvd, Sacramento, CA 95817-2208 | 2013-04-02 |
| 1043579501 | Nhat Minh Pham | Pediatrics | 2825 Capitol Ave, Sacramento, CA 95816 | 2012-05-03 |
| 1316238561 | Michelle Jane Lim | Pediatrics | 2516 Stockton Blvd, Sacramento, CA 95817-2208 | 2011-04-22 |
| 1982925368 | Blair R. L. Colwell | Pediatrics | 2315 Stockton Blvd, Dept. of Pediatrics, Ucdmc, Sacramento, CA 95817-2201 | 2010-06-19 |
| Find all providers in SACRAMENTO | ||||
| City | SACRAMENTO |
| Zip Code | 95817 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.