Provider Demographics
NPI:1841625548
Name:UCLA HEM/ONC IRVINE
Entity type:Organization
Organization Name:UCLA HEM/ONC IRVINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-653-2959
Mailing Address - Street 1:4746 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4728
Mailing Address - Country:US
Mailing Address - Phone:949-653-2959
Mailing Address - Fax:949-653-5589
Practice Address - Street 1:4746 BARRANCA PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4728
Practice Address - Country:US
Practice Address - Phone:949-653-2959
Practice Address - Fax:949-653-5589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64196261QX0200X
CAG58036261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology