Provider Demographics
NPI:1235212465
Name:UNIVERSITY CALIFORNIA IRVINE MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY CALIFORNIA IRVINE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN PEDIATRIC DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:FEIZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAFFARN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:714-456-8470
Mailing Address - Street 1:222 VINTAGE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2823
Mailing Address - Country:US
Mailing Address - Phone:949-725-1013
Mailing Address - Fax:949-725-1013
Practice Address - Street 1:UCI MEDICAL CENTER, 100 THE CITY DRIVE, SOUTH
Practice Address - Street 2:BUILDING 56, SUITE 600 ZOT 4490
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3298
Practice Address - Country:US
Practice Address - Phone:714-456-6933
Practice Address - Fax:714-456-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-52952282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-03148Medicare UPIN