Healthcare Provider Details

I. General information

NPI: 1902778459
Provider Name (Legal Business Name): SP MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4695 MACARTHUR CT STE 1100
NEWPORT BEACH CA
92660-1866
US

IV. Provider business mailing address

4695 MACARTHUR CT STE 1100
NEWPORT BEACH CA
92660-1866
US

V. Phone/Fax

Practice location:
  • Phone: 949-253-5953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP WASEF
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 727-723-4392