Basic Information
| Provider Information | |||||||||
| NPI: | 1336392380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF CALIFORNIA - IRVINE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 MARC CT | ||||||||
| Address2: | |||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917654379 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 CITY BLVD W | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928682903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144565691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | IYER | ||||||||
| AuthorizedOfficialFirstName: | SONALI | ||||||||
| AuthorizedOfficialMiddleName: | LAKSHMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8478006953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | A103293 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.