Healthcare Provider Details

I. General information

NPI: 1275070021
Provider Name (Legal Business Name): MILLER CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 54559
LOS ANGELES CA
90054-0559
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5437
  • Fax: 562-933-8501
Mailing address:
  • Phone: 714-456-3724
  • Fax: 714-456-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL PORTO
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 714-456-2986