Healthcare Provider Details

I. General information

NPI: 1932157237
Provider Name (Legal Business Name): LPMI LONG BEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 WILLOW ST
SIGNAL HILL CA
90755-2217
US

IV. Provider business mailing address

PO BOX 1279
FORESTHILL CA
95631-1279
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-5120
  • Fax: 562-733-5880
Mailing address:
  • Phone: 530-367-5295
  • Fax: 530-367-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE (NONE) KAVON
Title or Position: V.P. MARKETING & CONTRACTING
Credential:
Phone: 530-367-5295