Provider Demographics
NPI:1235187311
Name:UC REGENTS UCI DEPT OF PEDIATRICS
Entity Type:Organization
Organization Name:UC REGENTS UCI DEPT OF PEDIATRICS
Other - Org Name:REGENT OF THE UNIVERSITY OF CALIFORNIA
Other - Org Type:Other Name
Authorized Official - Title/Position:UPS PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:UCI HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVIDER RELATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 31001-2494
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-8068
Practice Address - Fax:714-456-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54107ZOtherBLUE SHIELD GROUP #
CAZZZ54113ZOtherBLUE SHIELD GROUP #
CAZZZ54104ZOtherBLUE SHIELD
CAZZZ54109ZOtherBLUE SHIELD GROUP #
CAZZZ54112ZOtherBLUE SHIELD GROUP #
CAZZZ04921ZOtherBLUE SHIELD GROUP #
CACG7642OtherRAILROAD MEDICARE GROUP
CAGR0029040OtherMEDI-CAL GROUP #
CAZZZ17751ZOtherBLUE SHIELD GROUP #
CAZZZ06275ZOtherBLUE SHIELD GROUP #
CAZZZ54114ZOtherBLUE SHIELD GROUP #
CAZZZ54103ZOtherBLUE SHIELD GROUP #
CAZZZ54106ZOtherBLUE SHIELD GROUP #
CAZZZ54104ZOtherBLUE SHIELD
CAHW11812Medicare ID - Type UnspecifiedGENETIC MEDICARE GROUP