Healthcare Provider Details

I. General information

NPI: 1740220482
Provider Name (Legal Business Name): NEWPORT CRITICAL CARE PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOAG DRIVE 3 NORTH INTENSIVIST OFFICE
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

PO BOX 749226
LOS ANGELES CA
90074-9226
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6875
  • Fax: 949-764-6874
Mailing address:
  • Phone: 949-263-8620
  • Fax: 949-263-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECA LAGUNA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 442-600-5128