Healthcare Provider Details

I. General information

NPI: 1205885357
Provider Name (Legal Business Name): NEWPORT HARBOR ANESTHESIA CONSULTANTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOAG DRIVE DEPARTMENT OF ANESTHESIOLOGY
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

ONE HOAG DRIVE DEPARTMENT OF ANESTHESIOLOGY
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6954
  • Fax: 949-764-5674
Mailing address:
  • Phone: 949-764-6954
  • Fax: 949-764-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DALE CULLY
Title or Position: PRESIDENT
Credential: MD
Phone: 949-764-6954