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General NPI Number Information
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NPI Number | 1639053036
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Entity Type | Organization
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Legal Business Name | CC SOUTHBAY MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3655 LOMITA BLVD STE 421
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City | TORRANCE
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State | CA
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Zip | 90505-1934
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Country | US
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Telephone | 562-316-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 LOMITA BLVD STE 421
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City | TORRANCE
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State | CA
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Zip | 90505-1934
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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 | CFO
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Name | ROGGIELYZ PADILLA
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Credential |
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Telephone | 562-316-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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