Provider Demographics
NPI:1518684430
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWABESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-5180
Mailing Address - Street 1:1500 S DOUGLASS RD, 2ND FLOOR
Mailing Address - Street 2:RT 183
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-509-6266
Mailing Address - Fax:
Practice Address - Street 1:856 MEDICAL SCIENCES QUAD ROOMS 2212, 2212A-B 2222
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-0001
Practice Address - Country:US
Practice Address - Phone:714-456-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy