Provider Demographics
NPI:1932117249
Name:NEWPORT DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:NEWPORT DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHEHABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-760-3025
Mailing Address - Street 1:PO BOX 8073
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8073
Mailing Address - Country:US
Mailing Address - Phone:949-760-3025
Mailing Address - Fax:949-720-3944
Practice Address - Street 1:1605 AVOCADO
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-760-3025
Practice Address - Fax:949-720-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13996Medicare PIN