Healthcare Provider Details

I. General information

NPI: 1407058787
Provider Name (Legal Business Name): UC IRVINE UNIVERSITY PHYSICIANS & SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE SUITE #315
ORANGE CA
92868-3217
US

IV. Provider business mailing address

200 S MANCHESTER AVE SUITE #315
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8721
  • Fax:
Mailing address:
  • Phone: 714-456-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCELE A HAYMOND
Title or Position: MANAGER
Credential:
Phone: 714-456-8721