Provider Demographics
NPI:1275993412
Name:LB MULTISPECIALTY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:LB MULTISPECIALTY MEDICAL GROUP INC.
Other - Org Name:PREVIOUSLY CARE FIRST MEDICAL GROUP INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-423-0330
Mailing Address - Street 1:4401 ATLANTIC AVE, SUITE 480
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2218
Mailing Address - Country:US
Mailing Address - Phone:562-423-0330
Mailing Address - Fax:
Practice Address - Street 1:4401 ATLANTIC AVE SUITE 480
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-423-0330
Practice Address - Fax:567-422-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68934207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty