Provider Demographics
NPI:1063610582
Name:NEWPORT ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:NEWPORT ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-759-0995
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-759-0995
Mailing Address - Fax:949-759-5458
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 406
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-759-0995
Practice Address - Fax:949-759-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty