Organization
UC IRVINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM RUSSEL M.D. (GME DIRECTOR)
(714) 456-7252
Entity
Organization
Contact information
Practice address
101 THE CITY DR S, BLDG 53, ROOM 302A, ORANGE, CA 92868-3201
(714) 456-8381
Mailing address
11 MOON DUST, IRVINE, CA 92603-3773
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A92819
CA
Other
Enumeration date
11/09/2007
Last updated
11/15/2007
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