Provider Demographics
NPI:1306042080
Name:NEWPORT BEACH INTERNAL MEDICINE INC.
Entity Type:Organization
Organization Name:NEWPORT BEACH INTERNAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WERNHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-722-3313
Mailing Address - Street 1:307 PLACENTIA AVE
Mailing Address - Street 2:100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3310
Mailing Address - Country:US
Mailing Address - Phone:949-642-0900
Mailing Address - Fax:949-642-0022
Practice Address - Street 1:307 PLACENTIA AVE
Practice Address - Street 2:100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3310
Practice Address - Country:US
Practice Address - Phone:949-642-0900
Practice Address - Fax:949-642-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68507Medicare ID - Type Unspecified
CAH16760Medicare UPIN