MEDICARE: COMPLETE WOMEN CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1144782491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE WOMEN CARE, INC.

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3300
Country	:	US
Telephone Number	:	562-424-8422
Fax Number	:	562-424-8770

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 279
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7602
Country	:	US
Telephone Number	:	562-424-8422
Fax Number	:	562-424-8770

Authorized Official
Title or Position	:	COO
Name	:	CARLA NIETO
Credential	:
Telephone Number	:	562-424-8422

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	06/11/2019

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