Provider Demographics
NPI:1417027475
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:UCI INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-824-5818
Mailing Address - Street 1:C240 MED SCI I
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-4069
Mailing Address - Country:US
Mailing Address - Phone:949-824-5818
Mailing Address - Fax:949-824-4362
Practice Address - Street 1:MEDICAL PLAZA DR
Practice Address - Street 2:ROOM 1619
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-0001
Practice Address - Country:US
Practice Address - Phone:949-824-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1918Medicare ID - Type UnspecifiedPROVIDER NUMBER