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General NPI Number Information
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NPI Number | 1780089425
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE MEDICAL MANAGEMENT, INC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 6011 PACIFIC BLVD STE 123
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2951
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Country | US
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Telephone | 323-585-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 6011 PACIFIC BLVD STE 123
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2951
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Country | US
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Telephone | 323-585-3552
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BOBBY LAWRENCE SMITH
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Credential | DC
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Telephone | 323-585-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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