Healthcare Provider Details

I. General information

NPI: 1164326401
Provider Name (Legal Business Name): EMBRACE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

IV. Provider business mailing address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-1977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER HAYNES
Title or Position: SR. DIRECTOR, COMPLIANCE
Credential: RN
Phone: 818-434-1977