Healthcare Provider Details

I. General information

NPI: 1831503812
Provider Name (Legal Business Name): NEWPORT BRACHYTHERAPY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SAN MIGUEL DR SUITE 235
NEWPORT BEACH CA
92660-7818
US

IV. Provider business mailing address

369 SAN MIGUEL DR SUITE 235
NEWPORT BEACH CA
92660-7818
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-2887
  • Fax:
Mailing address:
  • Phone: 949-706-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA80890
License Number StateCA

VIII. Authorized Official

Name: RANDALL ALAN SCHARLACH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 818-449-2700