=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477596583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG BEACH MEMORIAL MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 ATLANTIC AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-933-5437
-----------------------------------------------------
Fax | 562-933-8016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2801 ATLANTIC AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-933-5437
-----------------------------------------------------
Fax | 562-933-8016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF COMPLIANCE OFFICER
-----------------------------------------------------
Name | CHRIS FINCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-377-3218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC2000X
-----------------------------------------------------
Taxonomy Name | Children's Hospital
-----------------------------------------------------
License Number | 930000949
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------