=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083638530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF LONG BEACH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 GRAND AVE ROOM #260
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90815-1765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-570-4075
-----------------------------------------------------
Fax | 562-570-4070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 GRAND AVE ROOM #260
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90815-1765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-570-4075
-----------------------------------------------------
Fax | 562-570-4070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH OFFICER
-----------------------------------------------------
Name | ANISSA DANIELLE DAVIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 562-570-4047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------