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NPI Code Detail

MEDICARE: NEWPORT CENTER RADIOLOGY MEDICAL GROUP INC.

MEDICARE: NEWPORT CENTER RADIOLOGY MEDICAL GROUP INC.
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
1261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1205304433
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEWPORT CENTER RADIOLOGY MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : DEPT LA 21705
Second Line :
City : PASADENA
State : CA
Zip : 91185-1705
Country : US
Telephone Number : 949-263-8620
Fax Number : 714-727-1007
Provider Business Practice Location Address
First Line : 15000 KENSINGTON PARK DR
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1830
Country : US
Telephone Number : 714-477-8340
Fax Number : 714-477-8341
Authorized Official
Title or Position : PRESIDENT
Name : MICHAEL C ROOSSIN
Credential : MD
Telephone Number : 949-263-8620
Provider Enumeration Date : 11/06/2018
Last Update Date : 11/26/2018

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Directions to “NEWPORT CENTER RADIOLOGY MEDICAL GROUP INC. ” Practice Location

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