# UCI CARDIOLOGY- FOUNTAIN VALLEY

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

## Provider details

- **NPI number:** 1679012637
- **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:** 11180 WARNER AVE, SUITE 461, FOUNTAIN VALLEY, CA 92708-7501
- **Practice address phone:** (714) 751-3540
- **Practice address fax:** (714) 751-5626
- **Mailing address:** PO BOX 54509, LOS ANGELES, CA 90054-0509
- **Mailing address phone:** (714) 456-6655
- **Mailing address fax:** (714) 456-5747

## Taxonomy

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

## Other

- **Enumeration date:** 02/22/2017
- **Last updated:** 02/22/2017