Provider Demographics
NPI:1730273582
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, AMCARE PHARMACY SERVICES
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:858-249-4821
Mailing Address - Street 1:PO BOX 743475
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-3475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9610 RIDGEHAVEN CT STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5603
Practice Address - Country:US
Practice Address - Phone:619-543-5231
Practice Address - Fax:619-543-8220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000011251F00000X
CAPHE372843336M0002X, 3336S0011X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0549305OtherNABP
003738/C230OtherBLUE CROSS OF CA
CAPHA372840Medicaid
CAPHA372840Medicaid