Provider Demographics
NPI:1376862458
Name:NEWPORT FAMILY MEDICINE, INC
Entity Type:Organization
Organization Name:NEWPORT FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-1025
Mailing Address - Street 1:PO BOX 16027
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-6027
Mailing Address - Country:US
Mailing Address - Phone:949-574-4600
Mailing Address - Fax:949-574-4680
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-644-1025
Practice Address - Fax:949-644-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14259Medicare PIN