Provider Demographics
NPI:1427218288
Name:NEWPORT MEDICAL CARE
Entity Type:Organization
Organization Name:NEWPORT MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-544-6050
Mailing Address - Street 1:13420 NEWPORT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3745
Mailing Address - Country:US
Mailing Address - Phone:714-544-6050
Mailing Address - Fax:
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-544-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty