1366774481 NPI number — UNIVERSITY OF CALIFORNIA, IRVINE, MEDICAL CENTER

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 1366774481 NPI number — UNIVERSITY OF CALIFORNIA, IRVINE, MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CALIFORNIA, IRVINE, MEDICAL CENTER
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:
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:
1366774481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 THE CITY DR S
Provider Second Line Business Mailing Address:
BLDG 3, RTE 88
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-5770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DR S
Provider Second Line Business Practice Location Address:
BLDG 3, RTE 88
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-5770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AROONLAP
Authorized Official First Name:
USA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRY RESIDENT PHYSICIAN
Authorized Official Telephone Number:
714-456-5770

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  A109987 , 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)





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