Healthcare Provider Details

I. General information

NPI: 1861567299
Provider Name (Legal Business Name): NEWPORT LANGUAGE AND SPEECH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23361 MADERO STE 200
MISSION VIEJO CA
92691-2715
US

IV. Provider business mailing address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

V. Phone/Fax

Practice location:
  • Phone: 949-599-0218
  • Fax: 949-859-0928
Mailing address:
  • Phone: 714-639-4990
  • Fax: 714-744-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP2796
License Number StateCA

VIII. Authorized Official

Name: MRS. LINDA SMITH
Title or Position: CEO
Credential:
Phone: 714-639-4990