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General NPI Number Information
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NPI Number | 1306042080
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Entity Type | Organization
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Legal Business Name | NEWPORT BEACH INTERNAL MEDICINE INC.
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 307 PLACENTIA AVE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3310
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Country | US
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Telephone | 949-642-0900
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Fax | 949-642-0022
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Provider Business Mailing Address
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Address Line | 307 PLACENTIA AVE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3310
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Country | US
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Telephone | 949-642-0900
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Fax | 949-642-0022
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Authorized Official
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Title or Position | PRESIDENT
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Name | WERNHER OVALLE
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Credential | M.D
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Telephone | 949-722-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A68507
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License Number State | CA
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