MEDICARE: BEACH ALLERGY & ASTHMA SPECIALTY GROUP

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	207K00000X	Allergy & Immunology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ22603Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1902873060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH ALLERGY & ASTHMA SPECIALTY GROUP

Provider Business Mailing Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	SUITE 209
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2147
Country	:	US
Telephone Number	:	562-496-4749
Fax Number	:	562-429-3329

Provider Business Practice Location Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	SUITE 209
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2147
Country	:	US
Telephone Number	:	562-496-4749
Fax Number	:	562-429-3329

Authorized Official
Title or Position	:	PARTNER
Name	:	STEVEN MARK MELTZER
Credential	:	M.D.
Telephone Number	:	562-496-4749

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/23/2021

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