Organization
NEWPORT CRITICAL CARE PHYSICIANS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECA LAGUNA (CREDENTIALING MANAGER)
(442) 600-5128
Entity
Organization
Contact information
Practice address
ONE HOAG DRIVE, 3 NORTH INTENSIVIST OFFICE, NEWPORT BEACH, CA 92663-4162
(949) 764-6875
(949) 764-6874
Mailing address
PO BOX 749226, LOS ANGELES, CA 90074-9226
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0090550
—
CA
01
—
ZZZ02938Z
BLUE SHIELD OF CA
CA
Enumeration date
06/08/2006
Last updated
04/11/2024
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