Healthcare Provider Details

I. General information

NPI: 1306296835
Provider Name (Legal Business Name): MY PEDIATRICS AND RESPIRATORY CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALAMITOS AVE
LONG BEACH CA
90813-4726
US

IV. Provider business mailing address

720 ALAMITOS AVE
LONG BEACH CA
90813-4726
US

V. Phone/Fax

Practice location:
  • Phone: 562-489-7405
  • Fax: 562-489-7406
Mailing address:
  • Phone: 562-489-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA114034
License Number StateCA

VIII. Authorized Official

Name: DR. LEILA MARIAM YOONESSI
Title or Position: M.D./CEO
Credential: M.D. MPH.
Phone: 562-489-7405