Organization
REGENTS OF THE UNIV OF CA
Active
Other names
UCD Hemostatis Lab
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
2315 STOCKTON BLVD, #2205, SACRAMENTO, CA 95817-2201
(916) 734-3548
Mailing address
10850 WHITE ROCK RD, RANCHO CORDOVA, CA 95670-6044
(916) 734-9200
(916) 734-9661
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI4127
RAILROAD MEDICARE PIN
AR
01
—
CN4400
RAILROAD MEDICARE PIN
CA
01
—
CN4844
RAILROAD MEDICARE PIN
CA
01
—
CR0028
RAILROAD MEDICARE PIN
CA
01
—
DA4168
RAILROAD MEDICARE PIN
CA
01
—
DE7275
RAILROAD MEDICARE PIN
CA
05
—
ZZZ59285Z
—
CA
01
—
ZZZP5701Z
MEDICAID/CHDP PIN
CA
Enumeration date
10/13/2005
Last updated
05/16/2025
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