Organization Active NPI

Cynthia L Miller Dobalian a Medical Corporation

  • Specialist
  • Long Beach, CA
National Provider Identifier
1699040535
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G51792 Issued in CA
Legal business name
CYNTHIA L MILLER DOBALIAN A MEDICAL CORPORATION
Practice address
3816 Woodruff Ave
Suite #307
Long Beach, CA 90808-2147
Phone
(562) 420-7670
NPI assigned
Mar 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cynthia Louise Miller-Dobalian, M.D.
Title
Ceo
Phone
(562) 420-7670

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X G51792 CA Primary

Addresses

Primary practice location

3816 Woodruff Ave
Suite #307
Long Beach, CA 90808-2147

Mailing address

3816 Woodruff Ave
Suite #307
Long Beach, CA 90808-2147
Phone (562) 420-7670

Other identifiers 1

IdentifierTypeStateIssuer
00G517920MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120309000387 CA Part B Supplier - Clinic/Group Practice 0446419584 Receives reassigned benefits from 1 practitioner
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1699040535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE",
            "address_2": "SUITE #307",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908082147",
            "telephone_number": "562-420-7670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3816 WOODRUFF AVE",
            "address_2": "SUITE #307",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908082147",
            "telephone_number": "562-420-7670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYNTHIA L MILLER DOBALIAN A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-11",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "MILLER-DOBALIAN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-420-7670",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G51792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G517920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.