Organization
PID ASSOCIATES MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDRA DEVEIKIS M.D. (MEDICAL DIRECTOR)
(562) 933-8590
Entity
Organization
Contact information
Practice address
2801 ATLANTIC AVE, LONG BEACH, CA 90806-1701
(562) 933-8590
(562) 933-8093
Mailing address
1536 W 25TH ST, PMB 163, SAN PEDRO, CA 90732-4415
(562) 933-8590
(562) 933-8093
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
A40896
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CGP144665
CCS/CHP NUMBER
CA
05
—
GR0041670
—
CA
Enumeration date
09/08/2006
Last updated
02/12/2019
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