Healthcare Provider Details

I. General information

NPI: 1255668976
Provider Name (Legal Business Name): ALAMITOS BEACH CITIES PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CHERRY AVE
LONG BEACH CA
90802-3848
US

IV. Provider business mailing address

304 CHERRY AVE
LONG BEACH CA
90802-3848
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-3846
  • Fax: 562-438-3690
Mailing address:
  • Phone: 562-496-3846
  • Fax: 562-438-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4826
License Number StateCA

VIII. Authorized Official

Name: DR. MIE SHIRAI
Title or Position: COO
Credential: DPM
Phone: 562-496-3846