Healthcare Provider Details

I. General information

NPI: 1699068940
Provider Name (Legal Business Name): LONG BEACH MEMORIAL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 TERMINO AVE
LONG BEACH CA
90804-2104
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-1000
  • Fax: 562-933-8016
Mailing address:
  • Phone: 562-933-5437
  • Fax: 562-933-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. YAIR KATZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 562-933-5437