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General NPI Number Information
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NPI Number | 1548340045
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Entity Type | Organization
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Legal Business Name | GASTROINTESTINAL & LIVER DISEASES OF NEWPORT, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 1525 SUPERIOR AVE STE 208
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3639
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Country | US
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Telephone | 626-840-8419
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Fax | 949-705-6774
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Provider Business Mailing Address
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Address Line | PO BOX 9409
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-9409
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Country | US
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Telephone | 626-840-8419
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Fax | 949-705-6774
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Authorized Official
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Title or Position | OWNER
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Name | EUGENE R PANTANGCO
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Credential | M.D.
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Telephone | 626-840-8419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A74336
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License Number State | CA
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