Provider Demographics
NPI:1023448511
Name:GROWING HEALTHY TOGETHER INC., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GROWING HEALTHY TOGETHER INC., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VICIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:562-473-4441
Mailing Address - Street 1:3835 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5303
Mailing Address - Country:US
Mailing Address - Phone:562-473-4441
Mailing Address - Fax:562-473-4447
Practice Address - Street 1:3835 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5303
Practice Address - Country:US
Practice Address - Phone:562-473-4441
Practice Address - Fax:562-473-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22745208000000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty