| Full Name | |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 101 The City Dr S, Orange, California |
| Authorized Official Name and Position | Uci Health Provider Relations (UPS PROVIDER RELATIONS) |
| Authorized Official Contact | 7144562986 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 31001-2482 Pasadena CA 91110-2482 Ph: () - | 101 The City Dr S Orange CA 92868 Ph: (714) 456-8068 |
| NPI Number | 1902854078 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 08/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902854078 | NPI | - | NPPES |
| CU0494 | Other | CA | RAILROAD MEDICARE GROUP |
| ZZZP3010Z | Other | CA | MEDI-CAL GROUP # |
| ZZZ53992Z | Other | CA | BLUE SHIELD GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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