Healthcare Provider Details

I. General information

NPI: 1992012512
Provider Name (Legal Business Name): CHOICES OF LONG BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 SAINT LOUIS AVE
LONG BEACH CA
90804-4557
US

IV. Provider business mailing address

774 SAINT LOUIS AVE
LONG BEACH CA
90804-4557
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-9010
  • Fax:
Mailing address:
  • Phone: 562-590-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number306003752
License Number StateCA

VIII. Authorized Official

Name: MISS DESIREE GARCIA
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 562-590-9010