Healthcare Provider Details

I. General information

NPI: 1528401783
Provider Name (Legal Business Name): NEWPORT CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 OLD NEWPORT BLVD
NEWPORT BEACH CA
92663-4233
US

IV. Provider business mailing address

441 OLD NEWPORT BLVD
NEWPORT BEACH CA
92663-4233
US

V. Phone/Fax

Practice location:
  • Phone: 949-491-9991
  • Fax: 949-612-9795
Mailing address:
  • Phone: 949-491-9991
  • Fax: 949-612-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA92732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA97592
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA106704
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KASRA ROWSHAN
Title or Position: SPINE SURGEON, OWNER
Credential: M.D.
Phone: 949-491-9991