Healthcare Provider Details

I. General information

NPI: 1366939373
Provider Name (Legal Business Name): YVETTE M GOZZO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200A
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200A
NEWPORT BEACH CA
92663-3664
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8070
  • Fax: 949-764-4241
Mailing address:
  • Phone: 949-764-8070
  • Fax: 949-764-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YVETTE MARIE GOZZO
Title or Position: PHYSICIAN/SOLE OWNER
Credential: MD
Phone: 908-705-4992