MEDICARE: MRS. DEANNE ELISE NEWTON MSPAS, PA-C, CN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	001135	CA
2	363A00000X	Physician Assistant	PA 14830	CA

General Provider Information

NPI Number	:	1336319839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEANNE ELISE NEWTON MSPAS, PA-C, CN

Provider Business Mailing Address
First Line	:	617 SOUTH BROADWAY
Second Line	:	APT 5
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277
Country	:	US
Telephone Number	:	310-540-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 ORANGE AVE STE C
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2839
Country	:	US
Telephone Number	:	949-574-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	08/19/2019

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