Healthcare Provider Details

I. General information

NPI: 1518916527
Provider Name (Legal Business Name): UCI DEPARTMENT OF DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 31001-2462
PASADENA CA
91110-2462
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: UCI HEALTH PROVIDER RELATIONS
Title or Position: UPS PROVIDER RELATIONS
Credential:
Phone: 714-456-2986