Healthcare Provider Details

I. General information

NPI: 1871535278
Provider Name (Legal Business Name): LONG BEACH PET IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 E WILLOW ST
SIGNAL HILL CA
90755-2217
US

IV. Provider business mailing address

2708 E WILLOW ST
SIGNAL HILL CA
90755-2217
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-3652
  • Fax: 562-427-3652
Mailing address:
  • Phone: 562-427-3652
  • Fax: 562-427-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number6936-19
License Number StateCA

VIII. Authorized Official

Name: JEFFREY A. DOBKIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 562-427-0714