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General NPI Number Information
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NPI Number | 1154765709
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Entity Type | Organization
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Legal Business Name | NEWPORT CHILDREN MEDICAL GROUP AT MISSION
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE 510
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-364-8700
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Fax | 949-365-1011
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Provider Business Mailing Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE 510
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-364-8700
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Fax | 949-365-1011
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHANNA RODRIGUEZ-TOLEDO
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Credential | M. D.
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Telephone | 949-364-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | A47947
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A109148
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License Number State | CA
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