MEDICARE: PATHWAYS TO LIFE

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	261QC1500X	Community Health Clinic/Center		CA

General Provider Information

NPI Number	:	1679773683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS TO LIFE

Provider Business Mailing Address
First Line	:	1125 CHERRY AVE
Second Line	:	SUITE A
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3911
Country	:	US
Telephone Number	:	562-256-1388
Fax Number	:	562-256-1635

Provider Business Practice Location Address
First Line	:	1125 CHERRY AVE
Second Line	:	SUITE A
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3911
Country	:	US
Telephone Number	:	562-256-1388
Fax Number	:	562-256-1635

Authorized Official
Title or Position	:	CEO
Name	:	DR. PRUDENCIA KINTAUDI
Credential	:	M.D.
Telephone Number	:	562-256-1388

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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Directions to “PATHWAYS TO LIFE ” Practice Location

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