Provider Demographics
NPI:1356005920
Name:NEWPORT LABS INC
Entity Type:Organization
Organization Name:NEWPORT LABS INC
Other - Org Name:NEWPORT LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAZERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-463-9876
Mailing Address - Street 1:1820 E GARRY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5804
Mailing Address - Country:US
Mailing Address - Phone:949-463-9876
Mailing Address - Fax:949-480-0701
Practice Address - Street 1:1820 E GARRY AVE STE 112
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5804
Practice Address - Country:US
Practice Address - Phone:949-463-9876
Practice Address - Fax:949-480-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory