Healthcare Provider Details

I. General information

NPI: 1568834059
Provider Name (Legal Business Name): KEITH A HURVITZ M D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST STE 380
LONG BEACH CA
90815-1444
US

IV. Provider business mailing address

6226 E SPRING ST STE 380
LONG BEACH CA
90815-1444
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-6543
  • Fax: 562-595-1414
Mailing address:
  • Phone: 562-595-6543
  • Fax: 562-595-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA74511
License Number StateCA

VIII. Authorized Official

Name: DR. KEITH A HURVITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-595-6543