Basic Information
| Provider Information | |||||||||
| NPI: | 1790711927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWPORT HARBOR PATHOLOGY MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W COAST HWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498911297 | ||||||||
| FaxNumber: | 9492584354 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W COAST HWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498911297 | ||||||||
| FaxNumber: | 9492584354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | EPSTEIN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9497645635 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | FNP 23213 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | GR0076400 | 05 | CA | MEDICAID | ZZZ51273Z | 01 | CA | BLUE SHIELD | OTHER |