Healthcare Provider Details

I. General information

NPI: 1124145545
Provider Name (Legal Business Name): SAMUEL A NEWMAN M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 MARTIN STE 200
IRVINE CA
92612-1406
US

IV. Provider business mailing address

PO BOX 4283
SAN CLEMENTE CA
92674-4283
US

V. Phone/Fax

Practice location:
  • Phone: 949-752-7071
  • Fax:
Mailing address:
  • Phone: 949-837-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC25066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: