Healthcare Provider Details

I. General information

NPI: 1710297262
Provider Name (Legal Business Name): SANCHEZ LONG BEACH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 PACIFIC AVE SUITE 203
LONG BEACH CA
90806-2625
US

IV. Provider business mailing address

2512 DEERFORD ST
LAKEWOOD CA
90712-3356
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-2600
  • Fax:
Mailing address:
  • Phone: 310-639-2600
  • Fax: 310-630-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A7037
License Number StateCA

VIII. Authorized Official

Name: DR. SAMUEL EFRAIN SANCHEZ
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 310-639-2600