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NPI Code Detail

MEDICARE: PACE- UC IRVINE HEALTH, INTERNAL MEDICINE

MEDICARE: PACE- UC IRVINE HEALTH, INTERNAL MEDICINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1790148534
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACE- UC IRVINE HEALTH, INTERNAL MEDICINE
Provider Business Mailing Address
First Line : PO BOX 54509
Second Line :
City : LOS ANGELES
State : CA
Zip : 90054-0509
Country : US
Telephone Number : 714-456-6585
Fax Number : 714-456-8101
Provider Business Practice Location Address
First Line : 13300 GARDEN GROVE BLVD
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92843-2207
Country : US
Telephone Number : 714-468-1100
Fax Number : 714-468-1071
Authorized Official
Title or Position : PRESIDENT
Name : DR. MANUEL PORTO
Credential : M.D.
Telephone Number : 714-456-2986
Provider Enumeration Date : 03/30/2016
Last Update Date : 03/30/2016

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