Jesse J Licuanan (NPI# 1396795514, PAC ID# 3678547601) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1396795514 |
| PAC ID by PECOS | 3678547601 |
| Professional Enrollment ID | I20040824001319 |
| Full Name | Jesse J Licuanan |
| Organization Legal Name | PROHEALTH PARTNERS, A MEDICAL GROUP |
| Address |
3300 E S St Suite 205 Long Beach CA 90805-4587 |
| Phone Number | 5625310377 |
| Gender | M |
| Credential | MD |
| Graduation Year | 1999 |
| Primary Specialty | INTERNAL MEDICINE |
| Secondary Specialties | GENERAL PRACTICE |
| Group Practice PAC ID | 2769388412 |
| Number of Group Practice Members | 205 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050191 | ST MARY MEDICAL CENTER |
| 050581 | LAKEWOOD REGIONAL MEDICAL CENTER |
| 050485 | LONG BEACH MEMORIAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1050 Linden Ave, Long Beach, CA 90813-3321 | 5624919000 | PROHEALTH PARTNERS, A MEDICAL GROUP |
| 3300 E S St, Suite 205, Long Beach, CA 90805-4587 | 5625310377 | PROHEALTH PARTNERS, A MEDICAL GROUP |
| Organization Legal Name | PROHEALTH PARTNERS, A MEDICAL GROUP |
| Physicians | 192 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer Ann Oberhart | Internal Medicine | Prohealth Partners, A Medical Group | 1050 Linden Ave, Long Beach, CA 90813-3321 |
| Tiffany Lynn Mcvey | Nurse Practitioner | Prohealth Partners, A Medical Group | 2777 Pacific Ave, Suite E, Long Beach, CA 90806-2626 |
| Samir Samarany | Cardiovascular Disease (cardiology) | Prohealth Partners, A Medical Group | 685 N 13th Ave, Suite 9, Upland, CA 91786-4963 |
| Leticia K Gonzalez | Physician Assistant | Prohealth Partners, A Medical Group | 7643 Atlantic Ave, Cudahy, CA 90201-5019 |
| Corinne Kaveny | Physician Assistant | Prohealth Partners, A Medical Group | 1045 Atlantic Ave, Suite 1019, Long Beach, CA 90813-3413 |
| Carol Veneracion-godoy | Physician Assistant | Prohealth Partners, A Medical Group | 711 E Rosecrans Ave, Compton, CA 90221-2143 |
| Tina M Allee | Psychiatry | Prohealth Partners, A Medical Group | 2900 Bristol St, B203b205, Costa Mesa, CA 92626-5981 |
| Mona M Shah | General Surgery | Prohealth Partners, A Medical Group | 3628 E Imperial Hwy 202, Lynwood, CA 90262-2600 |
| Sabeen Munib | Family Medicine | Prohealth Partners, A Medical Group | 23181 La Cadena Dr, Suite 101, Laguna Hills, CA 92653-1479 |
| Nayna A Paryani | Nurse Practitioner | Prohealth Partners, A Medical Group | 1868 Pacific Ave, Long Beach, CA 90806-6113 |
| Street Address |
3300 E S ST SUITE 205 |
| City | LONG BEACH |
| State | CA |
| Zip | 90805-4587 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Richard Arthur Rosenberg | Podiatry | 3300 E S St, Suite 306, Lakewood, CA 90805-4595 | |
| Leslie A Lin | Anesthesiology | 3300 E S St, Lakewood, CA 90805-4549 | |
| Mohsen Tabrizi | Endocrinology | Steven L Eng Md Inc | 3300 E S St, Suite 103, Lakewood, CA 90805-4582 |
| Antiem Bui | Nephrology | Southland Renal Medical Group, Inc | 3300 E S St, Suite 308, Lakewood, CA 90805-4598 |
| Gnyandev Patel | Internal Medicine | 3300 E S St, Suite 206, Lakewood, CA 90805-4590 | |
| Shamila Senanayake | Nephrology | Moti S Daswani Md Inc | 3300 E S St, Suite 110, Long Beach, CA 90805 |
| Melissa Sarah Hawks | Physician Assistant | Southland Renal Medical Group, Inc | 3300 E S St, Suite 308, Lakewood, CA 90805-4598 |
| Adarsh Daswani | Nephrology | Moti S Daswani Md Inc | 3300 E S St, Suite 110, Long Beach, CA 90805 |
| Willie Henry Goffney Jr. | Surgical Oncology | 3300 E S St, Suite 201, Long Beach, CA 90805-4588 | |
| Michael Alan Fischman | Nephrology | Southland Renal Medical Group, Inc | 3300 E S St, Suite 308, Lakewood, CA 90805-4598 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leon E Lis | Diagnostic Radiology | Beverly Radiology Medical Group IIi | 3715 E S St, Lakewood Open Mri, Long Beach, CA 90805 |
| Jose S Tandoc | Diagnostic Radiology | Beverly Radiology Medical Group IIi | 3715 E S St, Lakewood Open Mri, Long Beach, CA 90805 |
| Glenda L Romero Urquhart | Diagnostic Radiology | Beverly Radiology Medical Group IIi | 3715 E S St, Lakewood Open Mri, Long Beach, CA 90805 |
| Tae Y Lee | Nephrology | Moti S Daswani Md Inc | 3300 E S St, Suite 110, Long Beach, CA 90805 |
| Binh To Tran | Diagnostic Radiology | Beverly Radiology Medical Group IIi | 3715 E S St, Lakewood Open Mri, Long Beach, CA 90805 |
| Alice W Murphy | Physical Therapy | California Aquatic Therapy and Wellness Center Inc | 6801 Long Beach Blvd, Long Beach, CA 90805-1133 |
| John A Roohan | Family Practice | Joseph M Molina Md Professional Corporation-southern California | 540 E Artesia Blvd, Long Beach, CA 90805-1476 |
| Sulabha A Dave | Radiation Oncology | 2440 E S St, Long Beach, CA 90805-4426 | |
| Thu T Koeler | Optometry | 3705 E S St, Long Beach, CA 90805-4521 | |
| Alfred M Yamamoto | Pathology | Affiliated Pathologists Medical Group, Inc. | 3700 E S St, Lakewood, CA 90805-4521 |
| Find all physicians in zip 90805 | |||
| City | LONG BEACH |
| Zip Code | 90805 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | LONG BEACH + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Jesse J Licuanan.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.