Healthcare Provider Details

I. General information

NPI: 1063870541
Provider Name (Legal Business Name): UC IRVINE HEALTH - NEWPORT DOCTORS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD NEWPORT BLVD SUITE 201
NEWPORT BEACH CA
92663-4291
US

IV. Provider business mailing address

PO BOX 31001-1363
PASADENA CA
91110-1363
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2977
  • Fax: 949-546-0394
Mailing address:
  • Phone: 714-456-6324
  • Fax: 714-456-6273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL PORTO
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 714-456-2986