Healthcare Provider Details

I. General information

NPI: 1023998986
Provider Name (Legal Business Name): THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 ATLANTIC AVE STE 103
LONG BEACH CA
90813-3414
US

IV. Provider business mailing address

701 E 28TH ST STE 200
LONG BEACH CA
90806-2784
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-3114
  • Fax: 562-216-6179
Mailing address:
  • Phone: 562-264-3114
  • Fax: 562-216-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOU LEVASA
Title or Position: OPERATIONS & LICENSING SPECIALIST
Credential:
Phone: 562-264-3114