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General NPI Number Information
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NPI Number | 1689608150
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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 | 07/10/2006
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 101 THE CITY DR S
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City | ORANGE
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State | CA
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Zip | 92868-3201
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Country | US
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Telephone | 714-456-7890
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Fax | 714-456-7339
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLASS RD STE 200
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City | ANAHEIM
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State | CA
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Zip | 92806-6912
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Country | US
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Telephone | 916-240-3557
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Fax |
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Authorized Official
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Title or Position | CFO AND SR VP
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | CA
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