Healthcare Provider Details

I. General information

NPI: 1043182116
Provider Name (Legal Business Name): TEAM MEDICAL GROUP PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVENUE PICU DEPT.
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

6285 E SPRING ST # 288
LONG BEACH CA
90808-4020
US

V. Phone/Fax

Practice location:
  • Phone: 714-224-8853
  • Fax:
Mailing address:
  • Phone: 714-224-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JACKIE MILAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-224-8853