MEDICARE: FAMILY HEALTH CARE OF LONG BEACH MEDICAL GRP. 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	261Q00000X	Clinic/Center	G52798	CA

General Provider Information

NPI Number	:	1568529246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE OF LONG BEACH MEDICAL GRP. INC.

Provider Business Mailing Address
First Line	:	5977 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3752
Country	:	US
Telephone Number	:	562-421-3727
Fax Number	:	562-420-8948

Provider Business Practice Location Address
First Line	:	5977 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3752
Country	:	US
Telephone Number	:	562-421-3727
Fax Number	:	562-420-8948

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN DAVID MILLANE
Credential	:	M.D.
Telephone Number	:	562-421-3727

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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