Healthcare Provider Details

I. General information

NPI: 1164033684
Provider Name (Legal Business Name): FIRST CARE MULTISPECIALTY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ATLANTIC AVE STE 480
LONG BEACH CA
90807-2265
US

IV. Provider business mailing address

4401 ATLANTIC AVE STE 480
LONG BEACH CA
90807-2265
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA MONTAGUE
Title or Position: GENERAL COUNSEL
Credential: JD
Phone: 310-203-2800