Provider Demographics
NPI:1194877654
Name:OCEANPOINTE INCORPORATED
Entity type:Organization
Organization Name:OCEANPOINTE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRIENNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-597-6020
Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4013
Mailing Address - Country:US
Mailing Address - Phone:562-597-6020
Mailing Address - Fax:562-597-6074
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-597-6020
Practice Address - Fax:562-597-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7285207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7285OtherLICENSE
CABG6224252OtherDEA