Healthcare Provider Details
I. General information
NPI: 1275571903
Provider Name (Legal Business Name): REGIONAL PHYSICIANS IPA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/03/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2690 PACIFIC AVE SUITE 290
LONG BEACH CA
90806-2657
US
IV. Provider business mailing address
2690 PACIFIC AVE SUITE 290
LONG BEACH CA
90806-2657
US
V. Phone/Fax
- Phone: 562-599-0609
- Fax: 562-595-8884
- Phone: 562-599-0609
- Fax: 562-595-8884
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
SEN
BIN
LAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-599-0609