Healthcare Provider Details

I. General information

NPI: 1114349701
Provider Name (Legal Business Name): UC IRVINE CARDIOPULMONARY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 750
ORANGE CA
92868-4225
US

IV. Provider business mailing address

PO BOX 54559
LOS ANGELES CA
90054-0559
US

V. Phone/Fax

Practice location:
  • Phone: 855-563-5320
  • Fax: 714-456-4420
Mailing address:
  • Phone: 714-456-3724
  • Fax: 714-456-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANJAN S. BATRA
Title or Position: DIRECTOR, PEDIATRIC ELECTROPHYS
Credential: MD
Phone: 714-456-2986