Healthcare Provider Details

I. General information

NPI: 1407392145
Provider Name (Legal Business Name): UC IRVINE CANCER CENTER - NEWPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 NEWPORT BLVD SUITE 450
COSTA MESA CA
92627-3786
US

IV. Provider business mailing address

PO BOX 54778
LOS ANGELES CA
90054-0778
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2400
  • Fax: 949-999-2405
Mailing address:
  • Phone: 714-456-3851
  • Fax: 714-456-6216

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: DR. MANUEL PORTO
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 714-456-2986