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Organization
UC REGENTS UCI DEPT OF PEDIATRICS
Active
Organization
UC REGENTS UCI DEPT OF PEDIATRICS
Active
Other names
REGENT OF THE UNIVERSITY OF CALIFORNIA
Organization subpart
No
Provider details
NPI number
Authorized official
UCI HEALTH PROVIDER RELATIONS (UPS PROVIDER RELATIONS)
(714) 456-2986
Entity
Organization
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868
(714) 456-8068
(714) 456-3765
Mailing address
PO BOX 31001-2494, PASADENA, CA 91110-2494
Taxonomy
Speciality
Code
Description
License number
State
207SG0205X
Ph.D. Medical Genetics Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG7642
RAILROAD MEDICARE GROUP
CA
01
—
GR0029040
MEDI-CAL GROUP #
CA
01
—
ZZZ04921Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ06275Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ17751Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54103Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54104Z
BLUE SHIELD
CA
01
—
ZZZ54106Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54107Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54109Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54112Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54113Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ54114Z
BLUE SHIELD GROUP #
CA
Enumeration date
05/04/2006
Last updated
01/30/2019
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