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General NPI Number Information
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NPI Number | 1548700313
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Entity Type | Organization
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Legal Business Name | NEWPORT ID, INC.
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 9215 RESIDENCIA
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-9066
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Country | US
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Telephone | 201-888-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 9215 RESIDENCIA
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-9066
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Country | US
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Telephone | 201-888-3433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CATHERINE M KOPER
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Credential | M.D.
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Telephone | 201-888-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A131999
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License Number State | CA
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