# UC IRVINE HEALTH SPECIALTY CLINIC- TUSTIN (UROLOGY)

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** REGENTS OF THE UNIVERSITY OF CALIFORNIA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1265887756
- **Legal business name:** REGENTS OF THE UNIVERSITY OF CALIFORNIA
- **Authorized official:** DR. MANUEL PORTO M.D. (PRESIDENT)
- **Authorized official phone:** (714) 456-2986

## Contact information

- **Practice address:** 1451 IRVINE BLVD, TUSTIN, CA 92780-3804
- **Practice address phone:** (714) 456-7005
- **Practice address fax:** (877) 829-7891
- **Mailing address:** PO BOX 51342, LOS ANGELES, CA 90051-5642
- **Mailing address phone:** (714) 456-6054
- **Mailing address fax:** (714) 456-5342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/03/2016
- **Last updated:** 05/03/2016