MEDICARE: LONG BEACH SPRING FAMILY MEDICAL GRP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972642577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH SPRING FAMILY MEDICAL GRP

Provider Business Mailing Address
First Line	:	6510 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1554
Country	:	US
Telephone Number	:	562-421-4791
Fax Number	:	562-496-1180

Provider Business Practice Location Address
First Line	:	6510 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1554
Country	:	US
Telephone Number	:	562-421-4791
Fax Number	:	562-496-1180

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARED LEIGH PIETY
Credential	:	M.D.
Telephone Number	:	562-421-4791

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/24/2008

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