Healthcare Provider Details

I. General information

NPI: 1134635667
Provider Name (Legal Business Name): SELEM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N BELLFLOWER BLVD STE 201
LONG BEACH CA
90815-1144
US

IV. Provider business mailing address

2700 N BELLFLOWER BLVD STE 201
LONG BEACH CA
90815-1144
US

V. Phone/Fax

Practice location:
  • Phone: 562-938-9711
  • Fax: 562-938-9711
Mailing address:
  • Phone: 562-938-9711
  • Fax: 562-938-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52577
License Number StateCA

VIII. Authorized Official

Name: DR. HANAA HANNA
Title or Position: OWNER
Credential: MD
Phone: 562-938-9711