Basic Information
| Provider Information | |||||||||
| NPI: | 1720539711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UC IRVINE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 513228 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900513228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144566585 | ||||||||
| FaxNumber: | 7144568101 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 THE CITY DRIVE SOUTH, SENIOR CENTER, PAVILION IV | ||||||||
| Address2: | UC IRVINE MEDICAL CENTER - GERIATRICS, PRIMARY CARE | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144562332 | ||||||||
| FaxNumber: | 7144565997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | PORTO | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7144562986 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REGENTS OF THE UNIVERSITY OF CALIFORNIA | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.