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307 Placentia Ave Ste 202 Newport Beach CA 92663-3308 | |
| (949) 270-2100 | |
| (949) 515-5804 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 307 Placentia Ave Ste 202, Newport Beach, California |
| Authorized Official Name and Position | Christy Ward (CEO) |
| Authorized Official Contact | 9495363927 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 10159 Costa Mesa CA 92627-0050 Ph: (949) 270-2100 | 307 Placentia Ave Ste 202 Newport Beach CA 92663-3308 Ph: (949) 270-2100 |
| NPI Number | 1649648817 |
|---|---|
| Provider Enumeration Date | 09/04/2015 |
| Last Update Date | 07/29/2020 |
| Medicare PECOS PAC ID | 4789854993 |
|---|---|
| Medicare Enrollment ID | O20160418001502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649648817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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