Healthcare Provider Details

I. General information

NPI: 1619162302
Provider Name (Legal Business Name): DR. SULABHA DAVE M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 E SOUTH ST
LONG BEACH CA
90805-4426
US

IV. Provider business mailing address

2440 E SOUTH ST
LONG BEACH CA
90805-4426
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-0836
  • Fax: 562-633-8345
Mailing address:
  • Phone: 562-633-0836
  • Fax: 562-633-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA30598
License Number StateCA

VIII. Authorized Official

Name: DR. SULABHA A DAVE
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 562-633-0836