Healthcare Provider Details

I. General information

NPI: 1255545133
Provider Name (Legal Business Name): CITY OF LONG BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

IV. Provider business mailing address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

V. Phone/Fax

Practice location:
  • Phone: 562-570-4000
  • Fax: 562-570-4245
Mailing address:
  • Phone: 562-570-4331
  • Fax: 562-570-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANISSA DANIELLE DAVIS
Title or Position: CITY HEALTH OFFICER
Credential:
Phone: 562-570-4047