Provider Demographics
NPI:1306267554
Name:NEWPORT NEUROSPINE SPECIALISTS APC
Entity type:Organization
Organization Name:NEWPORT NEUROSPINE SPECIALISTS APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M. MOHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-284-0575
Mailing Address - Street 1:3420 BRISTOL ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7170
Mailing Address - Country:US
Mailing Address - Phone:949-284-0575
Mailing Address - Fax:949-284-0604
Practice Address - Street 1:3420 BRISTOL ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7170
Practice Address - Country:US
Practice Address - Phone:949-284-0575
Practice Address - Fax:949-284-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty