Healthcare Provider Details

I. General information

NPI: 1922425990
Provider Name (Legal Business Name): NEWPORT CARE URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W COAST HWY
NEWPORT BEACH CA
92663-4026
US

IV. Provider business mailing address

3300 WEST COAST HIGHWAY
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 949-491-9991
  • Fax: 949-258-5858
Mailing address:
  • Phone: 949-491-9991
  • Fax: 949-258-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9219
License Number StateCA

VIII. Authorized Official

Name: DR. FARZIN MOHTADI
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 949-491-9991