MEDICARE: LONG BEACH INTERNAL MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1861601981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH INTERNAL MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2650 ELM AVE STE 307
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-595-8549
Fax Number	:	562-492-6271

Provider Business Practice Location Address
First Line	:	2650 ELM AVE STE 307
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-595-8549
Fax Number	:	562-492-6271

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	DENISE PEREZ
Credential	:
Telephone Number	:	562-595-8549

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/26/2026

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