Healthcare Provider Details

I. General information

NPI: 1023293941
Provider Name (Legal Business Name): GAI SWEENEY ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAI TRAN

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E 7TH ST
LONG BEACH CA
90804-4590
US

IV. Provider business mailing address

2025 E 7TH ST
LONG BEACH CA
90804-4590
US

V. Phone/Fax

Practice location:
  • Phone: 562-284-0108
  • Fax: 562-284-0172
Mailing address:
  • Phone: 562-284-0108
  • Fax: 562-284-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberASW 19179
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number19179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: