Provider Demographics
NPI:1255398533
Name:UCI DEPARTMENT OF UROLOGY
Entity type:Organization
Organization Name:UCI DEPARTMENT OF UROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UPS PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:UCI HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVIDER RELATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 51342
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5642
Mailing Address - Country:US
Mailing Address - Phone:714-456-6054
Mailing Address - Fax:888-378-5391
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-8500
Practice Address - Fax:714-456-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54082ZOtherBLUE SHIELD GRP
CACG7652OtherRR MEDICARE
CAGR0085140Medicaid
CAW14887Medicare PIN