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General NPI Number Information
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NPI Number | 1871971002
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Entity Type | Organization
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Legal Business Name | UC IRVINE MEDICAL CENTER- ALS & NEUROMUSCULAR CENTER
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 200 S MANCHESTER AVE SUITE 110
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City | ORANGE
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State | CA
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Zip | 92868-3217
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Country | US
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Telephone | 714-456-2332
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Fax | 714-456-5997
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Provider Business Mailing Address
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Address Line | PO BOX 54778
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City | LOS ANGELES
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State | CA
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Zip | 90054-0778
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Country | US
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Telephone | 714-456-3851
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Fax | 714-456-6216
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Authorized Official
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Title or Position | INTERIM PRESIDENT
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Name | MANUEL PORTO
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Credential | MD
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Telephone | 714-456-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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