# UC IRVINE MEDICAL GROUP- TUSTIN

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

## Provider details

- **NPI number:** 1629454335
- **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) 938-8897
- **Practice address fax:** (714) 838-8988
- **Mailing address:** PO BOX 513980, LOS ANGELES, CA 90051-3980
- **Mailing address phone:** (714) 456-6431
- **Mailing address fax:** (714) 456-7754

## Taxonomy

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

## Other

- **Enumeration date:** 08/04/2015
- **Last updated:** 08/04/2015