| Memorial Family Medicine Medical Group, Inc. | |
|
1300 Avenida Vista Hermosa Suite 200 San Clemente CA 92673-6315 | |
| (949) 452-3199 | |
| (949) 218-6866 |
| Full Name | Memorial Family Medicine Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Avenida Vista Hermosa, San Clemente, California |
| Authorized Official Name and Position | Susan Yvonne Melvin (PRESIDENT/CEO) |
| Authorized Official Contact | 5629330055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Memorial Family Medicine Medical Group, Inc. 450 E Spring St Suite 1 Long Beach CA 90806-1625 Ph: (562) 933-0053 | Memorial Family Medicine Medical Group, Inc. 1300 Avenida Vista Hermosa Suite 200 San Clemente CA 92673-6315 Ph: (949) 452-3199 |
| NPI Number | 1154642452 |
|---|---|
| Provider Enumeration Date | 06/21/2010 |
| Last Update Date | 06/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154642452 | NPI | - | NPPES |
| GR0071000 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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