Organization
BACK BAY MEDICAL LLC
Active
Other names
Advanced Body Scan of Newport
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY A ROBERTSON MD (DIRECTOR)
(949) 756-8200
Entity
Organization
Contact information
Practice address
20311 SW ACACIA ST, SUITE 140, NEWPORT BEACH, CA 92660-1733
(949) 756-8200
(949) 203-8542
Mailing address
20311 SW ACACIA ST, SUITE 140, NEWPORT BEACH, CA 92660-1733
(949) 756-8200
(949) 203-8542
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
TG158
CA
Other
Enumeration date
07/31/2006
Last updated
10/22/2007
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