Provider Demographics
NPI:1871535278
Name:LONG BEACH PET IMAGING CENTER LLC
Entity type:Organization
Organization Name:LONG BEACH PET IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-427-0714
Mailing Address - Street 1:2708 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2217
Mailing Address - Country:US
Mailing Address - Phone:562-427-3652
Mailing Address - Fax:562-427-3652
Practice Address - Street 1:2708 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2217
Practice Address - Country:US
Practice Address - Phone:562-427-3652
Practice Address - Fax:562-427-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6936-19261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70146FMedicaid
CAZZZ01950ZOtherBLUE SHIELD
CA470001534OtherRAILROAD MEDICARE
CA470001534OtherRAILROAD MEDICARE