MEDICARE: STEVE VIBOL MENG BA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1518086370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE VIBOL MENG BA

Provider Business Mailing Address
First Line	:	2691 PASADENA AVENUE.
Second Line	:	APT. 10
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5013
Country	:	US
Telephone Number	:	562-424-1886
Fax Number	:	562-424-2296

Provider Business Practice Location Address
First Line	:	3530 ATLANTIC AVE STE 210
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4569
Country	:	US
Telephone Number	:	562-424-1886
Fax Number	:	562-424-2296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/04/2011

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