MEDICARE: NEWPORT COAST VEIN CARE, 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	2086S0129X	Vascular Surgery Physician	3783857	CA

General Provider Information

NPI Number	:	1548626294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT COAST VEIN CARE, INC.

Provider Business Mailing Address
First Line	:	447 OLD NEWPORT BLVD
Second Line	:	SUITE 200
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-612-8676
Fax Number	:	949-200-9695

Provider Business Practice Location Address
First Line	:	447 OLD NEWPORT BLVD
Second Line	:	SUITE 200
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4257
Country	:	US
Telephone Number	:	949-612-8676
Fax Number	:	949-200-9695

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AIDAN ALOYSIUS RANEY
Credential	:	M.D.
Telephone Number	:	949-612-8676

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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