Healthcare Provider Details

I. General information

NPI: 1336679109
Provider Name (Legal Business Name): UCR HEALTH - PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18881 VON KARMAN AVE # 1227
IRVINE CA
92612-1500
US

IV. Provider business mailing address

PO BOX 741696
LOS ANGELES CA
90074-1696
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax: 951-263-7238
Mailing address:
  • Phone: 518-277-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN FERENCIK
Title or Position: DIRECTOR, PHYSICIAN RELATIONS
Credential:
Phone: 951-827-7793