NPIMap

Organization Active NPI

Pacific CDDC

  • Medical Specialty Clinic/Center
  • Costa Mesa, CA
National Provider Identifier
1124402284
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
PACIFIC CDDC
Practice address
1640 Newport Blvd
Suite 350
Costa Mesa, CA 92627-3786
Phone
(949) 386-5260
Fax
(949) 515-0031
NPI assigned
Jul 17, 2015
Organization subpart
Yes
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Manuel Porto, MD
Title
Interim President
Phone
(714) 456-2986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

1640 Newport Blvd
Suite 350
Costa Mesa, CA 92627-3786

Mailing address

PO Box 54509
Los Angeles, CA 90054-0509
Phone (714) 456-3856

National Provider Directory

National Provider Directory
Tax ID family
UC Regents25 organizations share this tax ID, including this one
Part of
Regents of the University of California

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1124402284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54509",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900540509",
            "telephone_number": "714-456-3856",
            "fax_number": "714-456-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD",
            "address_2": "SUITE 350",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273786",
            "telephone_number": "949-386-5260",
            "fax_number": "949-515-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CDDC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENTS OF THE UNIVERSITY OF CALIFORNIA",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "PORTO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_title_or_position": "INTERIM PRESIDENT",
        "authorized_official_telephone_number": "714-456-2986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.