Provider Demographics
NPI:1518739309
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:UNIVERSITY OF CALIFORNIA IRVINE - CAC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-509-6266
Mailing Address - Street 1:1500 S DOUGLASS RD
Mailing Address - Street 2:SUITE 200, ROUTE 183
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19200 JAMBOREE ROAD
Practice Address - Street 2:SUITE 1500
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612
Practice Address - Country:US
Practice Address - Phone:714-456-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA IRVINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care