Provider Demographics
NPI:1629184619
Name:FIRST CHOICE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FIRST CHOICE MEDICAL ASSOCIATES INC
Other - Org Name:PAMELA R. KUSHNER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-6770
Mailing Address - Street 1:2865 ATLANTIC AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1740
Mailing Address - Country:US
Mailing Address - Phone:562-595-6770
Mailing Address - Fax:562-595-5553
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:562-595-6770
Practice Address - Fax:562-595-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG53239AMedicare ID - Type UnspecifiedMEDICARE
CAA93208Medicare UPIN