Healthcare Provider Details

I. General information

NPI: 1225629231
Provider Name (Legal Business Name): PAULINE SUJIN SAMBELI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULINE S PARK

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E 2ND ST
LONG BEACH CA
90803-5046
US

IV. Provider business mailing address

5700 E 2ND ST
LONG BEACH CA
90803-5046
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-4050
  • Fax: 657-276-4738
Mailing address:
  • Phone: 657-241-4050
  • Fax: 657-276-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF95012179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: