Provider Demographics
NPI:1114307493
Name:HIPPROCRATES OF CALIFORNIA MEDICAL GROUP
Entity Type:Organization
Organization Name:HIPPROCRATES OF CALIFORNIA MEDICAL GROUP
Other - Org Name:HIPPROCRATES OF CALIFORNIA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5621-981-2200
Mailing Address - Street 1:3605 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4013
Mailing Address - Country:US
Mailing Address - Phone:562-981-0022
Mailing Address - Fax:
Practice Address - Street 1:3605 LONG BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-981-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIPPROCRATES OF CALIFORNIA MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48974111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty