MEDICARE: BELMONT SHORE WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1235772609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELMONT SHORE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	5237 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5237 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5326
Country	:	US
Telephone Number	:	562-433-1200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIEP PHAM
Credential	:
Telephone Number	:	562-599-9220

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	10/17/2019

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Directions to “BELMONT SHORE WELLNESS CENTER ” Practice Location

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