Healthcare Provider Details

I. General information

NPI: 1245775360
Provider Name (Legal Business Name): NEWPORT PHYSICAL MEDICINE AND REHABILITATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17264 RED HILL AVE
IRVINE CA
92614-5628
US

IV. Provider business mailing address

17264 RED HILL AVE
IRVINE CA
92614-5628
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-1228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberA31505
License Number StateCA

VIII. Authorized Official

Name: DR. VINOD MALHORTA
Title or Position: PRESIDENT
Credential: MD
Phone: 949-650-1228