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General NPI Number Information
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NPI Number | 1467478008
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Entity Type | Organization
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Legal Business Name | NEWPORT CENTER MEDICAL GROUP
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 400 NEWPORT CENTER DR SUITE 504
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7601
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Country | US
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Telephone | 949-720-4920
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Fax | 949-720-4928
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Provider Business Mailing Address
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Address Line | 400 NEWPORT CENTER DR SUITE 504
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7601
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Country | US
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Telephone | 949-720-4920
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Fax | 949-720-4928
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. RONALD MARK TILSEN
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Credential | M.D.
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Telephone | 949-720-4920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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