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General NPI Number Information
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NPI Number | 1861720708
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Entity Type | Organization
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Legal Business Name | TRI CITY HEALTH GROUP
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 1145 E SAN ANTONIO DR STE A
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City | LONG BEACH
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State | CA
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Zip | 90807-2379
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Country | US
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Telephone | 562-984-5505
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Fax | 562-984-8599
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Provider Business Mailing Address
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Address Line | 1145 E SAN ANTONIO DR STE A
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City | LONG BEACH
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State | CA
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Zip | 90807-2379
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Country | US
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Telephone | 562-984-5505
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Fax | 562-984-8599
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VINCENT L. GUMBS
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Credential | M.D.
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Telephone | 562-984-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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