Provider Demographics
NPI:1528852548
Name:LONG BEACH-BIXBY KNOLLS MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:LONG BEACH-BIXBY KNOLLS MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-965-2233
Mailing Address - Street 1:3815 ATLANTIC AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3500
Mailing Address - Country:US
Mailing Address - Phone:562-426-9482
Mailing Address - Fax:562-424-1743
Practice Address - Street 1:3815 ATLANTIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3500
Practice Address - Country:US
Practice Address - Phone:562-426-9482
Practice Address - Fax:562-424-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care