Organization
SECRETS OF THE ISLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH A PEREZ B.O. (MANAGER)
(562) 940-5450
Entity
Organization
Contact information
Practice address
3821 ATLANTIC AVE, SUITE F, LONG BEACH, CA 90807-3534
(562) 940-5450
(562) 424-3235
Mailing address
3821 ATLANTIC AVE, SUITE F, LONG BEACH, CA 90807-3534
(562) 940-5450
(562) 424-3235
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720439755
NPI
CA
Enumeration date
06/30/2016
Last updated
07/20/2016
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