| Newport Beach Comprehensive Care Medical Group, Inc | |
|
355 Placentia Ave Suite 102 Newport Beach CA 92663-3311 | |
| (949) 574-1091 | |
| (949) 574-1097 |
| Full Name | Newport Beach Comprehensive Care Medical Group, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 355 Placentia Ave, Newport Beach, California |
| Authorized Official Name and Position | James Daniel Fondren (CEO) |
| Authorized Official Contact | 9495741091 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Newport Beach Comprehensive Care Medical Group, Inc 3419 Via Lido Pmb 349 Newport Beach CA 92663-3908 Ph: (949) 574-1091 | Newport Beach Comprehensive Care Medical Group, Inc 355 Placentia Ave Suite 102 Newport Beach CA 92663-3311 Ph: (949) 574-1091 |
| NPI Number | 1033305834 |
|---|---|
| Provider Enumeration Date | 09/15/2007 |
| Last Update Date | 12/06/2012 |
| Medicare PECOS PAC ID | 6002004421 |
|---|---|
| Medicare Enrollment ID | O20101229000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033305834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A60586 (California) | Primary |
| Provider Name | James D Fondren |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598781213 PECOS PAC ID: 7719175140 Enrollment ID: I20120517000615 |
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