Provider Demographics
NPI:1700471422
Name:NEWPORT MESA MEDICAL AND ACUPUNCTURE INC.
Entity Type:Organization
Organization Name:NEWPORT MESA MEDICAL AND ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-631-6042
Mailing Address - Street 1:2675 IRVINE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6674
Mailing Address - Country:US
Mailing Address - Phone:949-631-6042
Mailing Address - Fax:
Practice Address - Street 1:2675 IRVINE AVE STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6674
Practice Address - Country:US
Practice Address - Phone:949-631-6042
Practice Address - Fax:949-631-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty