Healthcare Provider Details

I. General information

NPI: 1770931529
Provider Name (Legal Business Name): GORETTI HO TAGHVA M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20360 SW BIRCH ST STE 180
NEWPORT BEACH CA
92660-1533
US

IV. Provider business mailing address

20360 SW BIRCH ST STE 180
NEWPORT BEACH CA
92660-1533
US

V. Phone/Fax

Practice location:
  • Phone: 949-945-2168
  • Fax:
Mailing address:
  • Phone: 949-945-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA108049
License Number StateCA

VIII. Authorized Official

Name: GORETTI HO TAGHVA
Title or Position: MD
Credential:
Phone: 949-945-2168