Provider Demographics
NPI:1558783696
Name:UC IRVINE HEALTH CANCER CENTER, NEWPORT PACIFIC MEDICAL CENTER
Entity Type:Organization
Organization Name:UC IRVINE HEALTH CANCER CENTER, NEWPORT PACIFIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-6270
Mailing Address - Street 1:PO BOX 31001-1363
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1363
Mailing Address - Country:US
Mailing Address - Phone:714-456-6324
Mailing Address - Fax:714-456-6273
Practice Address - Street 1:1640 NEWPORT BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-999-2400
Practice Address - Fax:949-999-2405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA IRVINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-08
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1930OtherMEDICARE ID-TYPE UNSPECIFIED