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General NPI Number Information
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NPI Number | 1164326401
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Entity Type | Organization
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Legal Business Name | EMBRACE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 3800 KILROY AIRPORT WAY STE 100
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City | LONG BEACH
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State | CA
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Zip | 90806-6818
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Country | US
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Telephone | 818-434-1977
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 KILROY AIRPORT WAY STE 100
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City | LONG BEACH
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State | CA
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Zip | 90806-6818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR. DIRECTOR, COMPLIANCE
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Name | JENNIFER HAYNES
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Credential | RN
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Telephone | 818-434-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NULL
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