Healthcare Provider Details

I. General information

NPI: 1073576757
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CITY DRIVE SOUTH BLDG 56 SUITE 800
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 54538
LOS ANGELES CA
90054-0538
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6431
  • Fax: 714-456-7754
Mailing address:
  • Phone: 714-456-6431
  • Fax: 714-456-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL PORTO
Title or Position: DEPT CHAIRMAN
Credential: MD
Phone: 714-456-6431