Basic Information
| Provider Information | |||||||||
| NPI: | 1619423282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWPORT HARBOR PATHOLOGY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W COAST HWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497644624 | ||||||||
| FaxNumber: | 9497645435 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 W LA VETA AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149973000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | EPSTEIN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9497644624 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.