REGENTS OF UNIVERSITY OF CALIFORNIA NPI 1003001009

Psychologist (Clinical Child & Adolescent) in Irvine, CA

Organization Psychologist Clinical Child & Adolescent

About REGENTS OF UNIVERSITY OF CALIFORNIA

Regents Of University Of California is a provider established in Irvine, California specializing in psychologist. The NPI number of Regents Of University Of California is 1003001009 and was assigned on September 2007. The practitioner's primary taxonomy code is 103TC2200X with license number PSY12351 (CA). The provider is registered as an organization and their NPI record was last updated 12 years ago. Regents Of University Of California operates as a single speciality business group with one or more individual providers who practice the same area of specialization.
The authorized official of this NPI record is Prof. Ronald A Kotkin (Clinical Professor)

NPI

1003001009

Provider NameREGENTS OF UNIVERSITY OF CALIFORNIA
Provider Location Address19262 JAMBOREE RD IRVINE, CA 92612
Provider Mailing Address19262 JAMBOREE RD IRVINE, CA 92612
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date09-12-2007
Last Update Date09-14-2007

Primary Taxonomy

Taxonomy Code103TC2200X
ClassificationPsychologist
TypeBehavioral Health & Social Service Providers
SpecializationClinical Child & Adolescent
License No.PSY12351
License StateCA

Business Address

REGENTS OF UNIVERSITY OF CALIFORNIA
19262 JAMBOREE RD
IRVINE, CA
ZIP 92612
Phone: (949) 824-2343
Fax: (949) 824-8737

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Mailing Address

REGENTS OF UNIVERSITY OF CALIFORNIA
19262 JAMBOREE RD
IRVINE, CA
ZIP 92612
Phone: (949) 824-2343
Fax: (949) 824-8737

Authorized Official

Authorized Official NamePROF. RONALD A KOTKIN
Authorized Official TitleCLINICAL PROFESSOR
Authorized Official Phone(949) 824-6292

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1033319405MS. ERICA REYES NGUYEN LCSW
Individual
Counselor (Mental Health)19262 JAMBOREE RD
IRVINE, CA 92612
(949) 824-2343
1427365659THE UNIVERSITY OF CALIFORNIA, IRVINE - CHILD DEVELOPMENT CENTER
Organization
Community/Behavioral Health19262 JAMBOREE RD
IRVINE, CA 92612
(949) 824-2343

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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