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4000 Birch St Suite 112a Newport Beach CA 92660-2211 | |
| (888) 256-2201 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4000 Birch St, Newport Beach, California |
| Authorized Official Name and Position | Deborah Casto (DIRECTOR OF COMPLIANCE) |
| Authorized Official Contact | 9496122712 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4000 Birch St Suite 112a Newport Beach CA 92660-2211 Ph: (888) 256-2201 | 4000 Birch St Suite 112a Newport Beach CA 92660-2211 Ph: (888) 256-2201 |
| NPI Number | 1265857213 |
|---|---|
| Provider Enumeration Date | 02/27/2014 |
| Last Update Date | 02/29/2024 |
| Certification Date | 02/29/2024 |
| Medicare PECOS PAC ID | 8426465295 |
|---|---|
| Medicare Enrollment ID | O20210322002636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265857213 | NPI | - | NPPES |
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