Healthcare Provider Details

I. General information

NPI: 1316770563
Provider Name (Legal Business Name): BEACH CITIES GATEWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 BART EARLE WAY STE 306
ROLLING HILLS ESTATES CA
90274-3667
US

IV. Provider business mailing address

1411 SILVIUS AVE
SAN PEDRO CA
90731-6039
US

V. Phone/Fax

Practice location:
  • Phone: 310-953-5169
  • Fax:
Mailing address:
  • Phone: 310-953-5169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LILIAN DEBBIE MURAD
Title or Position: FOUNDER/CEO
Credential: LCSW
Phone: 310-953-5169