Healthcare Provider Details

I. General information

NPI: 1841443686
Provider Name (Legal Business Name): CENTERS FOR FAMILY MEDICINE - FHCLB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 E SPRING ST
LONG BEACH CA
90808-3752
US

IV. Provider business mailing address

5626 OBERLIN DR SUITE 110
SAN DIEGO CA
92121-1705
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-3727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberG52798
License Number StateCA

VIII. Authorized Official

Name: KENNY HEINE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 858-625-2990