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NPI Code Detail

MEDICARE: MR. ERIC JASON MCMULLEN LPT

MEDICARE: MR. ERIC JASON MCMULLEN LPT
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
1167G00000XLicensed Psychiatric TechnicianPT27177CA
2167G00000XLicensed Psychiatric Technician27177CA

General Provider Information

NPI Number : 1386004299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC JASON MCMULLEN LPT
Provider Business Mailing Address
First Line : 6475 E PACIFIC COAST HWY STE 272
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-4201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3633 E BROADWAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-6035
Country : US
Telephone Number : 562-285-1330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2016
Last Update Date : 12/15/2025

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