Healthcare Provider Details

I. General information

NPI: 1033607296
Provider Name (Legal Business Name): HEALTH ATLAST LONG BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 PALO VERDE AVE STE 1J
LONG BEACH CA
90815-2360
US

IV. Provider business mailing address

2221 PALO VERDE AVE STE 1J
LONG BEACH CA
90815-2360
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-7007
  • Fax: 562-795-7009
Mailing address:
  • Phone: 562-795-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL NEWTON
Title or Position: CEO
Credential: DC
Phone: 562-795-7007