MEDICARE: NEWPORT BEACH OB/GYN 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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1497784193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT BEACH OB/GYN MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	351 HOSPITAL RD
Second Line	:	SUITE 316
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3509
Country	:	US
Telephone Number	:	949-642-5775
Fax Number	:	949-642-2037

Provider Business Practice Location Address
First Line	:	351 HOSPITAL RD
Second Line	:	SUITE 316
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3509
Country	:	US
Telephone Number	:	949-642-5775
Fax Number	:	949-642-2037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHANIE RICCI
Credential	:	MD
Telephone Number	:	949-642-5775

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/13/2015

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