Healthcare Provider Details

I. General information

NPI: 1194527184
Provider Name (Legal Business Name): SEAL BEACH MD BILLING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 PACIFIC COAST HWY SUITE D # 519
SEAL BEACH CA
90740-6200
US

IV. Provider business mailing address

1198 PACIFIC COAST HWY SUITE D # 519
SEAL BEACH CA
90740-6200
US

V. Phone/Fax

Practice location:
  • Phone: 714-759-2405
  • Fax:
Mailing address:
  • Phone: 714-759-2405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SWEENEY
Title or Position: CFO
Credential:
Phone: 714-759-2405