Provider Demographics
NPI:1417907379
Name:UCI PHYSICAL MEDICINE & REHABILITATION
Entity Type:Organization
Organization Name:UCI PHYSICAL MEDICINE & REHABILITATION
Other - Org Name:
Other - Org Type:
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:714-456-8026
Mailing Address - Street 1:PO BOX 31001-2482
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2482
Mailing Address - Country:US
Mailing Address - Phone:714-456-8026
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 10 ROOM 211
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-8702
Practice Address - Fax:714-456-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP3014ZOtherBLUESHIELD PROVIDER NUMBE
CAZZZP3014ZMedicaid
CAZZZP3014ZOtherBLUESHIELD PROVIDER NUMBE