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General NPI Number Information
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NPI Number | 1851325906
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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 | 07/11/2006
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 800 N MAIN ST
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City | SANTA ANA
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State | CA
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Zip | 92701
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Country | US
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Telephone | 714-456-6785
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S DOUGLASS RD #200, RT 183
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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 | 714-509-6266
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Fax |
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Authorized Official
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Title or Position | REIMBURSEMENT DIRECTOR
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Name | GINA CHURCHILL
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Credential |
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Telephone | 714-509-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | CA
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