| Organization Name: | REGENTS OF UNIVERSITY OF CALIFORNIA |
| NPI Number: | 1003001009 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD A KOTKIN (CLINICAL PROFESSOR) |
| Mailing Address: | 19262 Jamboree Rd Irvine |
| State: | CA US |
| Postal Code: | 926122502 |
| Phone Number: | 9498242343 |
| Fax Number: | 9498248737 |
| NPI Enumeration Date: | 09/12/2007 |
| NPI Last Update Date: | 09/14/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | PSY12351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |