Healthcare Provider Details

I. General information

NPI: 1497899587
Provider Name (Legal Business Name): HEALTH PSYCHOLOGY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE STE 203
LONG BEACH CA
90813-3266
US

IV. Provider business mailing address

1040 ELM AVE. SUITE 203
LONG BEACH CA
90813
US

V. Phone/Fax

Practice location:
  • Phone: 562-279-1476
  • Fax: 562-279-0211
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberBU20210972
License Number StateCA

VIII. Authorized Official

Name: OSCAR CRUZA
Title or Position: DIRECTOR
Credential:
Phone: 562-279-1476