Healthcare Provider Details

I. General information

NPI: 1528199643
Provider Name (Legal Business Name): ONE IN LONG BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 E. 4TH STREET
LONG BEACH CA
90814-1001
US

IV. Provider business mailing address

2017 E. 4TH STREET
LONG BEACH CA
90814-1001
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-4455
  • Fax: 562-433-6428
Mailing address:
  • Phone: 562-434-4455
  • Fax: 562-433-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PORTER GILBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 562-434-4455