Provider Demographics
NPI:1730579269
Name:UC IRVINE HEALTH PACIFIC COAST PLASTIC SURGERY
Entity type:Organization
Organization Name:UC IRVINE HEALTH PACIFIC COAST PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 515072
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5072
Mailing Address - Country:US
Mailing Address - Phone:714-456-5717
Mailing Address - Fax:714-456-7718
Practice Address - Street 1:1640 NEWPORT BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3786
Practice Address - Country:US
Practice Address - Phone:949-999-2411
Practice Address - Fax:949-999-2408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty