Provider Demographics
NPI:1639535412
Name:NEWPORT INSTITUTE OF THE MINIMALLY INVASIVE SURGERY
Entity Type:Organization
Organization Name:NEWPORT INSTITUTE OF THE MINIMALLY INVASIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-386-6718
Mailing Address - Street 1:455 OLD NEWPORT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:455 OLD NEWPORT BLVD
Practice Address - Street 2:STE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4241
Practice Address - Country:US
Practice Address - Phone:714-396-8777
Practice Address - Fax:714-917-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical