Healthcare Provider Details

I. General information

NPI: 1790711927
Provider Name (Legal Business Name): NEWPORT HARBOR PATHOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W COAST HWY STE 200
NEWPORT BEACH CA
92663-4045
US

IV. Provider business mailing address

2901 W COAST HWY STE 200
NEWPORT BEACH CA
92663-4045
US

V. Phone/Fax

Practice location:
  • Phone: 949-891-1297
  • Fax: 949-258-4354
Mailing address:
  • Phone: 949-891-1297
  • Fax: 949-258-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberFNP 23213
License Number StateCA

VIII. Authorized Official

Name: HOWARD D EPSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 949-764-5635