Provider Demographics
NPI:1902177785
Name:UC REGENTS
Entity Type:Organization
Organization Name:UC REGENTS
Other - Org Name:UCI HEALTH-FOUNTAIN VALLEY IMAGING-WARNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CHIEF FINANCIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:PERSEVERANCE
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:92806-6911
Mailing Address - Country:US
Mailing Address - Phone:714-456-6245
Mailing Address - Fax:714-456-6715
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-456-5676
Practice Address - Fax:714-456-6216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UC REGENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty