MEDICARE: NEWPORT PLAZA SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center		CA

General Provider Information

NPI Number	:	1013962521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT PLAZA SURGERY CENTER

Provider Business Mailing Address
First Line	:	1091 NEWPORT BLVD
Second Line	:	STE 240
City	:	COSTA MESA
State	:	CA
Zip	:	92627
Country	:	US
Telephone Number	:	949-515-1040
Fax Number	:	858-225-0292

Provider Business Practice Location Address
First Line	:	1091 NEWPORT BLVD
Second Line	:	STE 240
City	:	COSTA MESA
State	:	CA
Zip	:	92627
Country	:	US
Telephone Number	:	949-515-1040
Fax Number	:	858-225-0292

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	MARISALA RAMOS
Credential	:
Telephone Number	:	949-515-1040

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/22/2020

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