Provider Demographics
NPI:1669344339
Name:UNIVERSITY OF CALIFORNIA IRVINE
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA IRVINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO 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 STE 200
Mailing Address - Street 2:RTE 183
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-6912
Mailing Address - Country:US
Mailing Address - Phone:714-456-7890
Mailing Address - Fax:
Practice Address - Street 1:19210 JAMBOREE ROAD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:90223
Practice Address - Country:US
Practice Address - Phone:714-456-5514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy