Provider Demographics
NPI:1427438183
Name:CITY OF LONG BEACH
Entity type:Organization
Organization Name:CITY OF LONG BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CITY HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-570-4047
Mailing Address - Street 1:2525 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1765
Practice Address - Country:US
Practice Address - Phone:562-570-4155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN258359251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare