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General NPI Number Information
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NPI Number | 1770142440
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Entity Type | Organization
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Legal Business Name | SOUTH BAY PSYCHIATRIC GROUP, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 2776 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-2613
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Country | US
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Telephone | 562-997-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4570
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City | PALOS VERDES PENINSULA
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State | CA
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Zip | 90274-9607
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Country | US
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Telephone | 424-400-7748
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HIRUY GESSESSE
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Credential | MD
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Telephone | 424-400-7748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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