| Vannarith So MD a Professional Corporation | |
|
1045 Atlantic Ave Suite 902 Long Beach CA 90813-3408 | |
| (562) 437-0996 | |
| (562) 495-4631 |
| Full Name | Vannarith So MD a Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 1045 Atlantic Ave, Long Beach, California |
| Authorized Official Name and Position | Vannarith So (OWNER) |
| Authorized Official Contact | 5624370996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vannarith So MD a Professional Corporation 1045 Atlantic Ave Suite 902 Long Beach CA 90813-3408 | Vannarith So MD a Professional Corporation 1045 Atlantic Ave Suite 902 Long Beach CA 90813-3408 Ph: (562) 437-0996 |
| NPI Number | 1386977353 |
|---|---|
| Provider Enumeration Date | 09/09/2009 |
| Last Update Date | 09/09/2009 |
| Medicare PECOS PAC ID | 5092846402 |
|---|---|
| Medicare Enrollment ID | O20100629000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386977353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Vannarith So |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659416584 PECOS PAC ID: 5395833560 Enrollment ID: I20071121000594 |
| Provider Name | Belita Sophia Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417624123 PECOS PAC ID: 0547654865 Enrollment ID: I20220303000608 |
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