Provider Demographics
NPI:1083895569
Name:UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, MENTAL HEALTH SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-824-1835
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER
Mailing Address - Street 2:501 STUDENT HEALTH
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-5200
Mailing Address - Country:US
Mailing Address - Phone:949-824-1835
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER
Practice Address - Street 2:501 STUDENT HEALTH
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-5200
Practice Address - Country:US
Practice Address - Phone:949-824-1835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20900251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare