| |
1300 Avenida Vista Hermosa Suite 200 San Clemente CA 92673-6315 | |
(949) 452-3199 | |
(949) 218-6866 |
Full Name | |
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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 |
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450 E Spring St Suite 1 Long Beach CA 90806-1625 Ph: (562) 933-0053 | 1300 Avenida Vista Hermosa Suite 200 San Clemente CA 92673-6315 Ph: (949) 452-3199 |
NPI Number | 1154642452 |
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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 |
Care Gastroenterology Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 655 Camino De Los Mares, Sute 123, San Clemente, CA 92673 Phone: 949-443-1546 Fax: 949-443-1077 | |
San Clemente Internal Medical Group Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 665 Camino De Los Mares Ste 309, San Clemente, CA 92673 Phone: 949-487-9034 Fax: 949-493-3721 | |
Joomo Yang, Md., Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2403 Camino Corso Rio, San Clemente, CA 92673 Phone: 949-226-8416 Fax: 949-226-8019 | |