Provider Demographics
NPI:1336392380
Name:UNIVERSITY OF CALIFORNIA - IRVINE MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA - IRVINE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONALI
Authorized Official - Middle Name:LAKSHMAN
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-800-6953
Mailing Address - Street 1:1020 MARC CT
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W
Practice Address - Street 2:SUITE 400
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2903
Practice Address - Country:US
Practice Address - Phone:714-456-5691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103293282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital