Provider Demographics
NPI:1134650849
Name:LEE G RAZALAN MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEE G RAZALAN MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAZALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-424-4661
Mailing Address - Street 1:2511 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3033
Mailing Address - Country:US
Mailing Address - Phone:562-424-4661
Mailing Address - Fax:562-427-3333
Practice Address - Street 1:2511 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3033
Practice Address - Country:US
Practice Address - Phone:562-424-4661
Practice Address - Fax:562-427-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30884261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308840Medicaid
CA00A30884Medicare UPIN
CAA30884Medicare PIN