Organization
NEWPORT CHILDREN'S MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERON GILLIARD CMPE (HEALTH ADMINISTRATOR)
(949) 644-0970
Entity
Organization
Contact information
Practice address
1401 AVOCADO AVE, #802, NEWPORT BEACH, CA 92660-7720
(949) 644-0970
(949) 644-0774
Mailing address
1401 AVOCADO AVE, #802, NEWPORT BEACH, CA 92660-7720
(949) 644-0970
(949) 644-0774
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0083890
—
CA
05
—
GR0083892
—
CA
Enumeration date
12/29/2005
Last updated
10/09/2007
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