Provider Demographics
NPI:1942489190
Name:LONG BEACH OBSTETRICS GYNECOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LONG BEACH OBSTETRICS GYNECOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-1961
Mailing Address - Street 1:2840 LONG BEACH #230
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2840 LONG BEACH BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1575
Practice Address - Country:US
Practice Address - Phone:562-595-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH21402Medicare UPIN
CAA32848Medicare UPIN
CAE72960Medicare UPIN
CAE15055Medicare UPIN
CAA48013Medicare UPIN
CAF11932Medicare UPIN