Healthcare Provider Details

I. General information

NPI: 1598203242
Provider Name (Legal Business Name): UC IRVINE MEDICAL CENTER - INTERNAL MEDICINE WEIGHT MGMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S PAVILION III
ORANGE CA
92868-3201
US

IV. Provider business mailing address

PO BOX 31001-2482
PASADENA CA
91110-2482
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7002
  • Fax: 714-456-2949
Mailing address:
  • Phone: 714-456-3856
  • 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: DR. MANUEL PORTO
Title or Position: PERSIDENT & CEO
Credential: MD
Phone: 714-456-2986