Provider Demographics
NPI:1467797522
Name:MILLER CHILDREN'S HOSPITAL CENTER
Entity Type:Organization
Organization Name:MILLER CHILDREN'S HOSPITAL CENTER
Other - Org Name:LONG BEACH MEMORIAL MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEDDI
Authorized Official - Middle Name:LYNNEA
Authorized Official - Last Name:SOFTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-933-8600
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:MCH-LONG BEACH MEMORIAL MEDICAL CENTER
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-2000
Mailing Address - Fax:
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:MCH-LONG BEACH MEMORIAL MEDICAL CENTER
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG BEACH MEMORIAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15718281PC2000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No281PC2000XHospitalsChronic Disease HospitalChildren