=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033559141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWPORT SLEEP AND WELLNESS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2013
-----------------------------------------------------
Last Update Date | 09/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 NEWPORT BLVD STE 440
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92627-3786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-554-0588
-----------------------------------------------------
Fax | 949-229-6464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10840 WALKER ST
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90630-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-923-0046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DENNIS OBERST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-923-0046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number | BT30043797
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------