Provider Demographics
NPI:1649576034
Name:GREATER NEWPORT PHYSICIANS ANTICOAGULATION CENTER
Entity Type:Organization
Organization Name:GREATER NEWPORT PHYSICIANS ANTICOAGULATION CENTER
Other - Org Name:GREATER NEWPORT PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY CLINICAL SERV
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECORO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-574-4413
Mailing Address - Street 1:500 SUPERIOR AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3657
Mailing Address - Country:US
Mailing Address - Phone:949-759-2222
Mailing Address - Fax:949-999-8154
Practice Address - Street 1:500 SUPERIOR AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3657
Practice Address - Country:US
Practice Address - Phone:949-759-2222
Practice Address - Fax:949-999-8154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER NEWPORT PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT30034380261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center