Provider Demographics
NPI:1861964157
Name:NEWMAN, ILENE
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20280 SW ACACIA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0782
Mailing Address - Country:US
Mailing Address - Phone:949-590-9350
Mailing Address - Fax:714-361-2606
Practice Address - Street 1:20280 SW ACACIA ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0782
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:714-361-2606
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist