Organization
REGENTS OF THE UNIV OF CA
Active
Other names
Regents UCD PBG Ped Cardi
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY TROVATTEN (VICE PRESIDENT, GOV'T REIMBURSEMENT)
(916) 855-2315
Entity
Organization
Contact information
Practice address
2521 STOCKTON BLVD, SACRAMENTO, CA 95817-2207
(916) 734-3179
(916) 456-2236
Mailing address
10850 WHITE ROCK RD, RANCHO CORDOVA, CA 95670-6044
(916) 734-9200
(916) 734-9661
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI4127
RAILROAD MEDICARE PIN
CA
01
—
CR0028
RAILROAD MEDICARE PIN
CA
05
—
GNP000070
—
CA
05
—
GR002104N
—
CA
01
—
ZZZP5701Z
MEDICAID/CHDP PIN
CA
Enumeration date
08/24/2005
Last updated
05/16/2025
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