NEWPORT CHILDREN'S MEDICAL GROUP NPI 1356328330

NPI Information

NPI: 1356328330
Provider Name: NEWPORT CHILDREN'S MEDICAL GROUP
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 05D0959609

Address:
1401 AVOCADO AVE
#802
NEWPORT BEACH, CA
ZIP 92660
Phone: (949) 644-0970
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NEWPORT CHILDREN'S MEDICAL GROUP is a primary care clinic center in Newport Beach, CA. NEWPORT CHILDREN'S MEDICAL GROUP NPI is 1356328330. The provider is registered as an organization entity type.

The provider's business location address is:

1401 AVOCADO AVE
#802
NEWPORT BEACH, CA
ZIP 92660-720
Phone: (949) 644-0970
Fax: (949) 644-0774

The provider's authorized official is Deron Gilliard .
The authorized official title is Health Administrator and has the following contact phone number (949) 644-0970.

The CLIA number assigned to this NPI record is 05D0959609 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/29/2005 and was last updated on 10/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0083890	MEDICAID	CALIFORNIA
2	GR0083892	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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