Healthcare Provider Details

I. General information

NPI: 1801432257
Provider Name (Legal Business Name): PEDIATRIC ENDOCRINOLOGY ASSOCIATES OF LONG BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 ELM AVE STE 210
LONG BEACH CA
90806-1600
US

IV. Provider business mailing address

126 N DEERWOOD ST
ORANGE CA
92869-4579
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-0166
  • Fax:
Mailing address:
  • Phone: 619-838-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PABLITO GARCIA NAGPALA
Title or Position: PRESIDENT
Credential: MD
Phone: 562-743-2838