MEDICARE: BE STAUB

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1629739552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BE STAUB

Provider Business Mailing Address
First Line	:	555 E OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5003
Country	:	US
Telephone Number	:	562-380-3112
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 E OCEAN BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5003
Country	:	US
Telephone Number	:	424-242-3012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	08/07/2023

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Directions to “ BE STAUB ” Practice Location

Language	Start Address	Practice Location

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