MEDICARE: ASPIRE PHYSICIAN ASSISTANT P.C.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1356211122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE PHYSICIAN ASSISTANT P.C.

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD UNIT 4622
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 LONG BEACH BLVD UNIT 4622
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3315
Country	:	US
Telephone Number	:	213-642-2400
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	MARY ROGERS
Credential	:
Telephone Number	:	213-642-2400

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	03/04/2026

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