Provider Demographics
NPI:1538216668
Name:UCI MEDICAL GROUP
Entity type:Organization
Organization Name:UCI MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INSTRUCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLISIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-279-6187
Mailing Address - Street 1:277 S BROOKHURST ST APT C218
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2456
Mailing Address - Country:US
Mailing Address - Phone:714-270-6187
Mailing Address - Fax:714-456-5390
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5705
Practice Address - Fax:714-456-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96059282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access