Provider Demographics
NPI:1508927948
Name:NEWPORT PATHOLOGY
Entity Type:Organization
Organization Name:NEWPORT PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-3127
Mailing Address - Street 1:1901 WESTCLIFF DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5598
Mailing Address - Country:US
Mailing Address - Phone:949-645-3127
Mailing Address - Fax:949-645-3157
Practice Address - Street 1:1901 WESTCLIFF DR
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5598
Practice Address - Country:US
Practice Address - Phone:949-645-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB02269GMedicaid