Provider Demographics
NPI:1902207806
Name:NEWPORT CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEWPORT CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-732-0303
Mailing Address - Street 1:3822 CAMPUS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2627
Mailing Address - Country:US
Mailing Address - Phone:949-863-9870
Mailing Address - Fax:949-863-9873
Practice Address - Street 1:3420 BRISTOL ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7170
Practice Address - Country:US
Practice Address - Phone:949-722-1112
Practice Address - Fax:949-631-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty