Provider Demographics
NPI:1427365659
Name:THE UNIVERSITY OF CALIFORNIA, IRVINE - CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:THE UNIVERSITY OF CALIFORNIA, IRVINE - CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-824-1812
Mailing Address - Street 1:19722 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2404
Mailing Address - Country:US
Mailing Address - Phone:949-824-1800
Mailing Address - Fax:949-824-1811
Practice Address - Street 1:19262 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2502
Practice Address - Country:US
Practice Address - Phone:949-824-2343
Practice Address - Fax:949-824-8737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-09
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14209251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health