Healthcare Provider Details

I. General information

NPI: 1073373726
Provider Name (Legal Business Name): CHAMPION HEALTH PLAN OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AIRPORT PLAZA DR STE 100
LONG BEACH CA
90815-1273
US

IV. Provider business mailing address

5000 AIRPORT PLAZA DR STE 100
LONG BEACH CA
90815-1273
US

V. Phone/Fax

Practice location:
  • Phone: 800-885-8000
  • Fax:
Mailing address:
  • Phone: 800-885-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: CONSTANCE SNYDER
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 562-682-9395