REGENTS OF UNIVERSITY OF CALIFORNIA NPI 1003001009

Psychologist (Clinical Child & Adolescent) in Irvine, CA

About REGENTS OF UNIVERSITY OF CALIFORNIA

Regents Of University Of California is a provider in Irvine, CA. The NPI number assigned to this provider is 1003001009. The practitioner's primary taxonomy code is Psychologist (103TC2200X). The provider is registered as an organization and their NPI record was last updated 11 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.

NPI

1003001009

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameREGENTS OF UNIVERSITY OF CALIFORNIA
Provider Location Address19262 JAMBOREE RD IRVINE, CA 92612 Additional informationCallout TooltipProvider 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 Address19262 JAMBOREE RD IRVINE, CA 92612 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
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).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. 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.
Enumeration Date09-12-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date09-14-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Primary Taxonomy

Taxonomy Code103TC2200X Additional informationCallout TooltipPrimary 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.
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 Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleCLINICAL PROFESSOR
Authorized Official Phone(949) 824-6292

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
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1003000993
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