NPIMap

Organization Active NPI

Susan Samueli Center

  • Multi-Specialty Clinic/Center
  • Costa Mesa, CA
National Provider Identifier
1770955593
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SUSAN SAMUELI CENTER
Practice address
1202 Bristol St
Suite 200
Costa Mesa, CA 92626-8605
Phone
(714) 424-9001
Fax
(714) 424-9005
NPI assigned
Oct 21, 2015
Organization subpart
Yes
Parent organization
REGENTS OF THE UNIVERSITY OF CALIFORNIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Authorized official

Name
Dr. Manuel Porto, M.D.
Title
President and C.E.O.
Phone
(714) 456-2986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1202 Bristol St
Suite 200
Costa Mesa, CA 92626-8605

Mailing address

PO Box 513620
Los Angeles, CA 90051-3620
Phone (714) 456-6585

National Provider Directory

National Provider Directory
Tax ID family
Pace- UC Irvine Health Family Medicine5 organizations share this tax ID, including this one
Part of
Regents of the University of California

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1770955593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 513620",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900513620",
            "telephone_number": "714-456-6585",
            "fax_number": "714-456-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 BRISTOL ST",
            "address_2": "SUITE 200",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926268605",
            "telephone_number": "714-424-9001",
            "fax_number": "714-424-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN SAMUELI CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENTS OF THE UNIVERSITY OF CALIFORNIA",
        "enumeration_date": "2015-10-21",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "PORTO",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_title_or_position": "PRESIDENT AND C.E.O.",
        "authorized_official_telephone_number": "714-456-2986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-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 Oct 21, 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.