Provider Demographics
NPI:1134324197
Name:NEWPORT PATHOLOGY
Entity Type:Organization
Organization Name:NEWPORT PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-458-9087
Mailing Address - Street 1:21911 DEVONSHIRE ST
Mailing Address - Street 2:SUITE #176
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 W 21ST ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-0323
Practice Address - Country:US
Practice Address - Phone:801-458-9087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory