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General NPI Number Information
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NPI Number | 1568493922
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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 | 07/05/2006
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 3751 KATELLA AVE
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-3101
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Country | US
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Telephone | 562-598-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLASS RD SUITE 200, RT 183
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City | ANAHEIM
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State | CA
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Zip | 92806-6911
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Country | US
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Telephone | 714-456-6245
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Fax | 714-456-6715
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Authorized Official
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Title or Position | VICE PRESIDENT AND CHIEF FINANCIAL
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Name | RANDOLPH PERSEVERANCE 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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 060000142
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License Number State | CA
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