Healthcare Provider Details

I. General information

NPI: 1467817437
Provider Name (Legal Business Name): UC IRVINE HEALTH - NEWPORT DOCTORS MEDICAL GROUP- NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/18/2015
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 54778
LOS ANGELES CA
90054-0778
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-2977
  • Fax: 949-548-0391
Mailing address:
  • Phone: 714-456-3851
  • Fax: 714-456-6216

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
Credential: M.D.
Phone: 714-456-2986