Healthcare Provider Details

I. General information

NPI: 1235165028
Provider Name (Legal Business Name): IRIS NEWBURY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23276 S POINTE DR SUITE 217
LAGUNA HILLS CA
92653-1432
US

IV. Provider business mailing address

9678 OAKMOUNT ST
CYPRESS CA
90630-3724
US

V. Phone/Fax

Practice location:
  • Phone: 949-338-4357
  • Fax: 714-827-3331
Mailing address:
  • Phone: 714-349-4357
  • Fax: 714-827-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: