Healthcare Provider Details

I. General information

NPI: 1154310753
Provider Name (Legal Business Name): LONG BEACH PAIN CENTER & MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 PACIFIC AVE
LONG BEACH CA
90806-2613
US

IV. Provider business mailing address

2760 PACIFIC AVE
LONG BEACH CA
90806-2613
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-7100
  • Fax:
Mailing address:
  • Phone: 562-427-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDY HOPKINS
Title or Position: CHIEF OPERATING OFFICER
Credential: RN
Phone: 562-446-2229