Healthcare Provider Details

I. General information

NPI: 1164800397
Provider Name (Legal Business Name): UC IRVINE WOMEN'S HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD SUITE 340
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

PO BOX 513980
LOS ANGELES CA
90051-3980
US

V. Phone/Fax

Practice location:
  • Phone: 949-752-4700
  • Fax: 949-753-0205
Mailing address:
  • Phone: 714-456-6431
  • Fax: 714-456-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANUEL PORTO
Title or Position: INTERIM PRESIDENT
Credential: MD
Phone: 714-456-2986