Healthcare Provider Details

I. General information

NPI: 1477596583
Provider Name (Legal Business Name): LONG BEACH MEMORIAL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1737
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5437
  • 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 Code282NC2000X
TaxonomyChildren's Hospital
License Number930000949
License Number StateCA

VIII. Authorized Official

Name: CHRIS FINCH
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 714-377-3218