Healthcare Provider Details

I. General information

NPI: 1164972360
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER LONG BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 ATLANTIC AVE
LONG BEACH CA
90805
US

IV. Provider business mailing address

3605 LONG BEACH BLVD SUITE 210
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-423-0491
  • Fax: 562-984-9611
Mailing address:
  • Phone: 562-279-1700
  • Fax: 562-279-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFREDO VELASCO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 562-279-1738