Provider Demographics
NPI:1902873060
Name:BEACH ALLERGY & ASTHMA SPECIALTY GROUP
Entity Type:Organization
Organization Name:BEACH ALLERGY & ASTHMA SPECIALTY GROUP
Other - Org Name:ALLERGY & ASTHMA CARE CENTER OF SOUTHERN CALIFORNIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-496-4749
Mailing Address - Street 1:3816 WOODRUFF AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2147
Mailing Address - Country:US
Mailing Address - Phone:562-496-4749
Mailing Address - Fax:562-429-3329
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-496-4749
Practice Address - Fax:562-429-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22603ZOtherBLUE SHIELD
CAW5072Medicare ID - Type Unspecified