Provider Demographics
NPI:1518300532
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR UCSD AMCARE PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-543-6194
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE 8765
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8765
Mailing Address - Country:US
Mailing Address - Phone:619-543-6194
Mailing Address - Fax:619-543-5829
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:STE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:760-536-7686
Practice Address - Fax:760-536-7685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA-UCSD MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51286333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518300532Medicaid
CA1518300532Medicaid