Provider Demographics
NPI:1528402203
Name:NEWPORT SPINE AND PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:NEWPORT SPINE AND PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SOHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZIASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-313-8333
Mailing Address - Street 1:19742 MACARTHUR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2408
Mailing Address - Country:US
Mailing Address - Phone:949-660-7246
Mailing Address - Fax:949-660-7249
Practice Address - Street 1:19742 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2408
Practice Address - Country:US
Practice Address - Phone:949-660-7246
Practice Address - Fax:949-660-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty