Healthcare Provider Details

I. General information

NPI: 1003138736
Provider Name (Legal Business Name): NEWPORT SURGICAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NEWPORT BLVD STE 120
COSTA MESA CA
92627-2278
US

IV. Provider business mailing address

1901 NEWPORT BLVD STE 120
COSTA MESA CA
92627-2278
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-1040
  • Fax: 949-650-5796
Mailing address:
  • Phone: 949-515-1040
  • Fax: 949-650-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN J HOGUE
Title or Position: CEO
Credential:
Phone: 949-706-9900