Provider Demographics
NPI:1932990793
Name:SEAL BEACH MEDICAL, LLC
Entity type:Organization
Organization Name:SEAL BEACH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLETOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-566-2829
Mailing Address - Street 1:1077 PACIFIC COAST HWY STE 293
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6214
Mailing Address - Country:US
Mailing Address - Phone:562-566-2829
Mailing Address - Fax:562-550-7560
Practice Address - Street 1:1198 PACIFIC COAST HWY
Practice Address - Street 2:SUITE D #519
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-566-2829
Practice Address - Fax:562-550-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty