Organization
NEWPORT CENTER RADIOLOGY ASSOCIATES MEDICAL GROUP INC
Active
Other names
Newport Imaging Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C ROOSSIN MD (PRESIDENT)
(949) 574-8200
Entity
Organization
Contact information
Practice address
360 SAN MIGUEL DR STE 106, NEWPORT BEACH, CA 92660
(949) 764-7480
(949) 721-9411
Mailing address
DEPT LA 21705, PASADENA, CA 91185-1705
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0027850
—
CA
01
—
ZZZ05509Z
BLUE SHIELD
CA
01
—
ZZZ13769Z
BLUE SHIELD
CA
01
—
ZZZ16877Z
BLUE SHIELD
CA
Enumeration date
06/15/2006
Last updated
08/20/2018
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