Provider Demographics
NPI:1447741657
Name:BRIDGE TO HEALTH LLC
Entity Type:Organization
Organization Name:BRIDGE TO HEALTH LLC
Other - Org Name:HEALTHBRIDGE NEWPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-842-0641
Mailing Address - Street 1:PO BOX 12131
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5053
Mailing Address - Country:US
Mailing Address - Phone:949-842-0641
Mailing Address - Fax:
Practice Address - Street 1:20271 SW BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1714
Practice Address - Country:US
Practice Address - Phone:949-715-9321
Practice Address - Fax:310-300-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty