Healthcare Provider Details

I. General information

NPI: 1043640063
Provider Name (Legal Business Name): CARDIN HEALTHCARE, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE STE 170
LONG BEACH CA
90806-1715
US

IV. Provider business mailing address

2880 ATLANTIC AVE SUITE 170
LONG BEACH CA
90806-1714
US

V. Phone/Fax

Practice location:
  • Phone: 562-492-9900
  • Fax: 562-492-9902
Mailing address:
  • Phone: 562-492-9900
  • Fax: 562-492-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN PAUL CARDIN JR.
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-492-9900