1184655581 NPI number — UNIVERSITY OF CALIFORNIA IRVINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184655581 NPI number — UNIVERSITY OF CALIFORNIA IRVINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CALIFORNIA IRVINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184655581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 S DOUGLASS RD
Provider Second Line Business Mailing Address:
SUITE 200, RT 183
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92806-6911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-6245
Provider Business Mailing Address Fax Number:
714-456-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-531-2550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIWABESSY
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
PERSEVERANCE
Authorized Official Title or Position:
VICE PRESIDENT AND CHIEF FINANCIAL
Authorized Official Telephone Number:
714-456-5180

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  930000046 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017523-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 684778260 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40581G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000405 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050581B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8091 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272609 . This is a "COVENTRY HEALTH CARE KANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30581G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1971Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".




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