Provider Demographics
NPI:1346822954
Name:BIXBY HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:BIXBY HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:310-736-5766
Mailing Address - Street 1:911 E SAN ANTONIO DR STE SUITE3
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2204
Mailing Address - Country:US
Mailing Address - Phone:310-736-5766
Mailing Address - Fax:
Practice Address - Street 1:911 E SAN ANTONIO DR STE 3
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2204
Practice Address - Country:US
Practice Address - Phone:562-423-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty