Provider Demographics
NPI:1386822930
Name:PANACEA HEALTHCARE MEDICAL GROUP
Entity Type:Organization
Organization Name:PANACEA HEALTHCARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOUADJ
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-3399
Mailing Address - Street 1:2630 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2611
Mailing Address - Country:US
Mailing Address - Phone:562-426-3399
Mailing Address - Fax:562-426-3797
Practice Address - Street 1:2630 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2611
Practice Address - Country:US
Practice Address - Phone:562-426-3399
Practice Address - Fax:562-426-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty