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General NPI Number Information
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NPI Number | 1518684430
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CALIFORNIA IRVINE
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 856 MEDICAL SCIENCES QUAD ROOMS 2212, 2212A-B 2222
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City | IRVINE
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State | CA
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Zip | 92697-0001
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Country | US
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Telephone | 714-456-5514
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLASS RD, 2ND FLOOR RT 183
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City | ANAHEIM
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State | CA
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Zip | 92806
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Country | US
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Telephone | 714-509-6266
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | RANDOLPH SIWABESSY
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Credential |
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Telephone | 714-456-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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