Healthcare Provider Details

I. General information

NPI: 1467797522
Provider Name (Legal Business Name): MILLER CHILDREN'S HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE MCH-LONG BEACH MEMORIAL MEDICAL CENTER
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE MCH-LONG BEACH MEMORIAL MEDICAL CENTER
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-2000
  • Fax:
Mailing address:
  • Phone: 562-933-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberPSY15718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberPSY15718
License Number StateCA

VIII. Authorized Official

Name: DR. TEDDI LYNNEA SOFTLEY
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 562-933-8600