MEDICARE: DR. MIGUEL OPORTOT PH.D.

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	103TC0700X	Clinical Psychologist	PSY20692	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY206920	OTHER	CA	MEDI-CAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568405538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL OPORTOT PH.D.

Provider Business Mailing Address
First Line	:	6615 E PACIFIC COAST HWY
Second Line	:	#255
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4211
Country	:	US
Telephone Number	:	562-799-6700
Fax Number	:	562-799-6733

Provider Business Practice Location Address
First Line	:	6615 E PACIFIC COAST HWY
Second Line	:	#255
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4211
Country	:	US
Telephone Number	:	562-799-6700
Fax Number	:	562-799-6733

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/23/2021

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