MEDICARE: NEWPORT HARBOR CARDIOLOGY INC

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	261QM2500X	Medical Specialty Clinic/Center	A99639	CA

General Provider Information

NPI Number	:	1952692782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT HARBOR CARDIOLOGY INC

Provider Business Mailing Address
First Line	:	601 DOVER DRIVE
Second Line	:	SUITE 2
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-5735
Country	:	US
Telephone Number	:	949-646-1495
Fax Number	:	949-646-2596

Provider Business Practice Location Address
First Line	:	601 DOVER DR STE 2
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-5700
Country	:	US
Telephone Number	:	949-646-1495
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	UTHARA RAJU MOHAN
Credential	:	M.D
Telephone Number	:	949-646-1495

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	10/27/2011

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