Organization
UC IRVINE HEALTH CDDC HIGH DESERT
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 M.D. (PRESIDENT)
(714) 456-2986
Entity
Organization
Contact information
Practice address
12595 HESPERIA RD, SUITE 101, VICTORVILLE, CA 92395-5882
(760) 269-3099
(760) 269-3038
Mailing address
PO BOX 512347, LOS ANGELES, CA 90051-0347
(714) 456-3856
(714) 456-6216
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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