Basic Information
| Provider Information | |||||||||
| NPI: | 1861567299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWPORT LANGUAGE AND SPEECH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W PROVIDENCE AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146394990 | ||||||||
| FaxNumber: | 7147443841 | ||||||||
| Practice Location | |||||||||
| Address1: | 23361 MADERO STE 200 | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926912715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495990218 | ||||||||
| FaxNumber: | 9498590928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7146394990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | SP2796 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ77842Z | 05 | CA | MEDICAID |