Healthcare Provider Details

I. General information

NPI: 1821043357
Provider Name (Legal Business Name): NEWPORT WALK IN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

IV. Provider business mailing address

2075 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-9222
  • Fax: 949-644-4312
Mailing address:
  • Phone: 949-760-9222
  • Fax: 949-644-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNN M STANTON
Title or Position: OWNER-PRESIDENT
Credential: MD
Phone: 949-760-9222