Provider Demographics
NPI:1790711927
Name:NEWPORT HARBOR PATHOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEWPORT HARBOR PATHOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-764-5635
Mailing Address - Street 1:2901 W COAST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4045
Mailing Address - Country:US
Mailing Address - Phone:949-891-1297
Mailing Address - Fax:949-258-4354
Practice Address - Street 1:2901 W COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4045
Practice Address - Country:US
Practice Address - Phone:949-891-1297
Practice Address - Fax:949-258-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 23213207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0076400Medicaid
CAZZZ51273ZOtherBLUE SHIELD
CAHW13976Medicare PIN