Healthcare Provider Details

I. General information

NPI: 1356510556
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFNORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MANCHESTER AVE SUITE 650
ORANGE CA
92868-3217
US

IV. Provider business mailing address

200 S MANCHESTER AVE SUITE 650
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-3228
  • Fax: 714-456-2229
Mailing address:
  • Phone: 714-456-3228
  • Fax: 714-456-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY EVANS
Title or Position: CHIEF DIVISION OF PLASTIC SURGERY
Credential: M.D.
Phone: 714-456-3228