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General NPI Number Information
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NPI Number | 1588053144
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Entity Type | Organization
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Legal Business Name | BEACH SIDE BIRTH CENTER LONG BEACH
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1224 E WARDLOW RD
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City | LONG BEACH
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State | CA
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Zip | 90807-4833
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Country | US
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Telephone | 562-912-4421
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Fax | 562-661-6084
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Provider Business Mailing Address
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Address Line | 24902 MOULTON PKWY SUITE 120
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City | LAGUNA HILLS
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State | CA
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Zip | 92637-6403
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Country | US
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Telephone | 949-215-7575
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Fax | 949-215-5757
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Authorized Official
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Title or Position | OFFICE AND BILLING MANAGEMENT
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Name | JEFFREY JOHN SNELL
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Credential |
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Telephone | 949-257-6652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | 550002843
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License Number State | CA
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