Healthcare Provider Details

I. General information

NPI: 1326145368
Provider Name (Legal Business Name): NEWPORT ORTHOPEDIC INSTITUTE, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7901
US

IV. Provider business mailing address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7901
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-5017
  • Fax: 949-432-3354
Mailing address:
  • Phone: 949-722-5017
  • Fax: 949-432-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANI ROSENE
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 949-722-5017