Healthcare Provider Details

I. General information

NPI: 1184543530
Provider Name (Legal Business Name): BORIS M. ACKERMAN, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR STE 607
NEWPORT BEACH CA
92660-7832
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 607
NEWPORT BEACH CA
92660-7832
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-3284
  • Fax:
Mailing address:
  • Phone: 949-759-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BORIS ACKERMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-759-3284