Healthcare Provider Details

I. General information

NPI: 1417907379
Provider Name (Legal Business Name): UCI PHYSICAL MEDICINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 10 ROOM 211
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 31001-2482
PASADENA CA
91110-2482
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8702
  • Fax: 714-456-6248
Mailing address:
  • Phone: 714-456-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: UCI HEALTH PROVIDER RELATIONS
Title or Position: UPS PROVIDER RELATIONS
Credential:
Phone: 714-456-8026