Healthcare Provider Details

I. General information

NPI: 1770027518
Provider Name (Legal Business Name): UC IRVINE HEALTH CANCER CENTER- NEWPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
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 54840
LOS ANGELES CA
90054-0840
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2400
  • Fax: 949-999-2405
Mailing address:
  • Phone: 714-456-3856
  • Fax: 714-456-8101

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
Credential: M.D.
Phone: 714-456-2986