Provider Demographics
NPI:1235135302
Name:NORTHWEST NEWBORN SPECIALISTS PC
Entity Type:Organization
Organization Name:NORTHWEST NEWBORN SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-243-3839
Mailing Address - Street 1:1301 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2843
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-851-1948
Practice Address - Street 1:770 THE CITY DR S
Practice Address - Street 2:SUITE 4000
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4900
Practice Address - Country:US
Practice Address - Phone:800-463-6628
Practice Address - Fax:714-740-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR148502Medicaid
WA7005937Medicaid
OR048003000OtherBCBS