MEDICARE: PANACEA HEALTHCARE MEDICAL GROUP 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	207R00000X	Internal Medicine Physician	A51505	CA

General Provider Information

NPI Number	:	1386822930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEA HEALTHCARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2630 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2611
Country	:	US
Telephone Number	:	562-426-3399
Fax Number	:	562-426-3797

Provider Business Practice Location Address
First Line	:	2630 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2611
Country	:	US
Telephone Number	:	562-426-3399
Fax Number	:	562-426-3797

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TOUADJ FARHADI
Credential	:	M.D.
Telephone Number	:	562-426-3399

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	10/29/2024

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