NPIMap

Organization Active NPI

Regents of the University of California

Doing business as Koman Family Outpatient Pavilion

  • Multi-Specialty Clinic/Center
  • La Jolla, CA
National Provider Identifier
1770042129
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Doing business as
Koman Family Outpatient Pavilion
Practice address
9400 Campus Point Dr
La Jolla, CA 92093-1350
Phone
(800) 926-8273
NPI assigned
Mar 15, 2019
Organization subpart
Yes
Parent organization
UCSD MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori Donaldson
Title
Cfo
Phone
(619) 543-6613

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

9400 Campus Point Dr
La Jolla, CA 92093-1350

Mailing address

File No 57326
Los Angeles, CA 90074-0001
Phone (858) 249-6748

Other names 1

  • Koman Family Outpatient Pavilion Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Regents of the University25 organizations share this tax ID, including this one
Part of
Regents of the University

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1770042129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NO 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "858-249-6748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920931350",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF CALIFORNIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UCSD MEDICAL CENTER",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "619-543-6613"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Koman Family Outpatient Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Jolla, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.