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20311 Sw Acacia St Ste 100 Newport Beach CA 92660-1733 | |
| (949) 520-1620 | |
| (949) 520-1550 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 20311 Sw Acacia St Ste 100, Newport Beach, California |
| Authorized Official Name and Position | Mocha Andrews (PRACTICE MANAGER) |
| Authorized Official Contact | 9495201620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
20311 Sw Acacia St Ste 100 Newport Beach CA 92660-1733 Ph: () - | 20311 Sw Acacia St Ste 100 Newport Beach CA 92660-1733 Ph: (949) 520-1620 |
| NPI Number | 1700612322 |
|---|---|
| Provider Enumeration Date | 09/10/2024 |
| Last Update Date | 12/05/2024 |
| Medicare PECOS PAC ID | 2769913128 |
|---|---|
| Medicare Enrollment ID | O20241009002343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700612322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Mona M Ghobrial |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033319173 PECOS PAC ID: 8628122249 Enrollment ID: I20110913000769 |
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