Healthcare Provider Details

I. General information

NPI: 1457809261
Provider Name (Legal Business Name): UC IRVINE HEALTH- YORBA LINDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19871 YORBA LINDA BLVD SUITE 104
YORBA LINDA CA
92886-2811
US

IV. Provider business mailing address

PO BOX 513620
LOS ANGELES CA
90051-3620
US

V. Phone/Fax

Practice location:
  • Phone: 714-777-3606
  • Fax: 714-777-3664
Mailing address:
  • Phone: 714-456-3724
  • Fax: 714-456-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL PORTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-456-2986