Provider Demographics
NPI:1922325877
Name:NEWPORT COAST PATHOLOGY, INC.
Entity Type:Organization
Organization Name:NEWPORT COAST PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANI
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTESHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:888-463-3606
Mailing Address - Street 1:27 CLERMONT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1069
Mailing Address - Country:US
Mailing Address - Phone:949-706-2796
Mailing Address - Fax:949-706-2072
Practice Address - Street 1:27 CLERMONT
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92657-1069
Practice Address - Country:US
Practice Address - Phone:949-706-2796
Practice Address - Fax:949-706-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74263291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory