Healthcare Provider Details

I. General information

NPI: 1376973040
Provider Name (Legal Business Name): PCH DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 E. PACIFIC COAST HWY SUITE B
LONG BEACH CA
90804
US

IV. Provider business mailing address

2990 E. PACIFIC COAST HWY SUITE B
LONG BEACH CA
90804
US

V. Phone/Fax

Practice location:
  • Phone: 562-343-7181
  • Fax:
Mailing address:
  • Phone: 562-343-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY LEE
Title or Position: MANAGER
Credential:
Phone: 714-417-5836