Provider Demographics
NPI:1134236250
Name:UCI PSYCH PRACTICE GROUP
Entity type:Organization
Organization Name:UCI PSYCH PRACTICE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:CHAITIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-5951
Mailing Address - Street 1:PO BOX 54739
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0739
Mailing Address - Country:US
Mailing Address - Phone:949-824-1283
Mailing Address - Fax:949-824-9891
Practice Address - Street 1:19722 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2404
Practice Address - Country:US
Practice Address - Phone:949-824-1283
Practice Address - Fax:949-824-9891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UC REGENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW3525Medicare ID - Type Unspecified