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General NPI Number Information
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NPI Number | 1528402203
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Entity Type | Organization
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Legal Business Name | NEWPORT SPINE AND PHYSICAL MEDICINE
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 19742 MACARTHUR BLVD STE 110
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City | IRVINE
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State | CA
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Zip | 92612-2408
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Country | US
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Telephone | 949-660-7246
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Fax | 949-660-7249
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Provider Business Mailing Address
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Address Line | 19742 MACARTHUR BLVD STE 110
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City | IRVINE
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State | CA
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Zip | 92612-2408
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Country | US
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Telephone | 949-660-7246
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Fax | 949-660-7249
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Authorized Official
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Title or Position | D.C.
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Name | SOHEILA GHAZIASKAR
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Credential | D.C.
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Telephone | 714-313-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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