Organization
PACIFIC CDDC
Active
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Organization subpart
Yes
Provider details
NPI number
Legal business name
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Authorized official
DR. MANUEL PORTO MD (INTERIM PRESIDENT)
(714) 456-2986
Entity
Organization
Contact information
Practice address
1640 NEWPORT BLVD, SUITE 350, COSTA MESA, CA 92627-3786
(949) 386-5260
(949) 515-0031
Mailing address
PO BOX 54509, LOS ANGELES, CA 90054-0509
(714) 456-3856
(714) 456-8101
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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