Provider Demographics
NPI:1396559498
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER AND SR. VP
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWABESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-5180
Mailing Address - Street 1:1500 S DOUGLASS RD
Mailing Address - Street 2:SUITE #200, RT 183
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6912
Mailing Address - Country:US
Mailing Address - Phone:949-445-8768
Mailing Address - Fax:
Practice Address - Street 1:1640 NEWPORT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-386-5011
Practice Address - Fax:949-386-5053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA IRVINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy