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General NPI Number Information
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NPI Number | 1144385998
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Entity Type | Organization
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Legal Business Name | NEWPORT MESA AUDIOLOGY INC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 500 OLD NEWPORT BOULEVARD STE 101
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-642-7935
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Fax | 949-642-2950
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Provider Business Mailing Address
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Address Line | 500 OLD NEWPORT BOULEVARD STE 101
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-642-7935
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Fax | 949-642-2950
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. HOWARD THOMAS MANGO
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Credential | AUD PHD
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Telephone | 949-642-7935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | AUD379
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License Number State | CA
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