Performance Boost Center, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PERFORMANCE BOOST CENTER, LLC

Practice address

1501 Superior Ave Ste 304
Newport Beach, CA 92663-3641

Phone

(949) 612-7811

Fax

(848) 612-7822

NPI assigned

Oct 7, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dean Glassman

Title

Owner

Phone

(626) 388-0700

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570406400000",
    "number": "1295376689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE STE 304",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633641",
            "telephone_number": "949-612-7811",
            "fax_number": "848-612-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE STE 304",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633641",
            "telephone_number": "949-612-7811",
            "fax_number": "848-612-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE BOOST CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2019-10-07",
        "status": "A",
        "authorized_official_last_name": "GLASSMAN",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-388-0700"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.