MEDICARE: NEWPORT BALBOA SURGERY CENTER, LLC

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	261QA0006X	Ambulatory Fertility Facility

General Provider Information

NPI Number	:	1033685441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT BALBOA SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	20360 SW BIRCH ST STE 210
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1534
Country	:	US
Telephone Number	:	858-967-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	20360 SW BIRCH ST STE 210
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1534
Country	:	US
Telephone Number	:	858-967-9343
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY J MCGINLEY
Credential	:
Telephone Number	:	949-637-3600

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/23/2018

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