Healthcare Provider Details

I. General information

NPI: 1740112770
Provider Name (Legal Business Name): HEALTHCARE IN ACTION MEDICAL GROUP WATERMAN P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

IV. Provider business mailing address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

V. Phone/Fax

Practice location:
  • Phone: 562-308-1195
  • Fax:
Mailing address:
  • Phone: 562-308-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HAYNES
Title or Position: SR. DIRECTOR, COMPLIANCE
Credential: RN
Phone: 818-434-1977