Organization
SUSAN SAMUELI CENTER
Active
Organization
SUSAN SAMUELI CENTER
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 AND C.E.O.)
(714) 456-2986
Entity
Organization
Contact information
Practice address
1202 BRISTOL ST, SUITE 200, COSTA MESA, CA 92626-8605
(714) 424-9001
(714) 424-9005
Mailing address
PO BOX 513620, LOS ANGELES, CA 90051-3620
(714) 456-6585
(714) 456-8101
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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