MEMORIAL MARITIME CLINIC, INC. (NPI# 1528122389) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528122389 |
| Entity Type | Organization |
| Organization Name | MEMORIAL MARITIME CLINIC, INC. |
| Practice Address |
150 S Pico Ave Long Beach CA 90802 |
| Practice Telephone | 5624322820 |
| Practice Fax Number | 5624371353 |
| Mailing Telephone | 5624322821 |
| Mailing Fax Number | 5624371353 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MARK PEREZ (OWNER) |
| Authorized Official Telephone | 5624322821 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | G067514 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD OF CA | 00G675140 | 01 |
| CA | G00675140 | 05 | |
| CA | MED LICENSE | G67514 | 01 |
| Street Address |
150 S PICO AVE |
| City | LONG BEACH |
| State | CA |
| Zip Code | 90802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629169396 | Keith William Mcgill | Dermatology | 150 S Pico Ave, 14342 Bora Dr La Mirada 90638, Long Beach, CA 90802 | 2006-09-27 |
| 1215170618 | Manuel Lemus | Physician Assistant | 150 S Pico Ave, Long Beach, CA 90802-6247 | 2009-04-14 |
| 1376669291 | Samantha L Honda | Physical Therapist | 150 S Pico Ave, Long Beach, CA 90802-6247 | 2007-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255981791 | Nena Danieles Meador | Technician | 505 West 5th St. Unit 201, Long Beach, CA 90802 | 2019-09-17 |
| 1881241487 | Edward De La Cruz | Technician | 425 E 3rd St., 413, Long Beach, CA 90802 | 2019-08-20 |
| 1992350094 | Kaitlyn May Saephan | Student in an Organized Health Care Education/Training Program | 200 Pine Avenue, Suite 400, Long Beach, CA 90802 | 2019-08-06 |
| 1073175881 | David Coleman | Counselor | 735 West 4th St, Unit D, Long Beach, CA 90802 | 2019-07-01 |
| 1235612193 | Linda Nyagaya | Nurse Practitioner | 200 Oceangate, Suite 100 Long Beach, Ca 90802, Long Beach, CA 90802 | 2018-09-06 |
| 1669998670 | Jessica Huerta | Student in an Organized Health Care Education/Training Program | 456 Elm, Long Beach, CA 90802 | 2017-08-22 |
| 1316462484 | Kathlyn Pearl Parlet | Counselor | 351 E. 6th. Street, Long Beach, CA 90802 | 2017-08-09 |
| 1386168136 | Shena Young | Psychologist | 404 East First St #1191, Long Beach, CA 90802 | 2017-08-02 |
| 1215472758 | Vanessa Pons | Marriage & Family Therapist | 735 W 4th St Unit A, Long Beach, CA 90802 | 2016-12-19 |
| 1821459330 | Surabhi Shah | Occupational Therapist | 330 Golden Shores, Suite 250, Long Beach, CA 90802 | 2016-03-10 |
| Find all providers in zip 90802 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144852435 | Clnica Uriel / Iradj Nazarian Md | Family Medicine | 1187 E Anaheim St, Long Beach, CA 90813-3662 | 2020-02-05 |
| 1104485887 | Pmd Wellness Center Inc. | Family Medicine | Pmd Wellness Center Inc, 1187 E. Anaheim St., Long Beach, CA 90813-3663 | 2019-06-06 |
| 1699248674 | Central Neighborhood Health Foundat | Family Medicine | 711 E Via Wanda, Long Beach, CA 90805-6526 | 2019-01-02 |
| 1629580337 | Kathleen Legaspi Hoops | Family Medicine | 865 Lees Ave, Long Beach, CA 90815-5024 | 2017-11-02 |
| 1609222942 | Prohealth Partners A Medical Group | Family Medicine | 3816 Woodruff Ave Ste 406, Long Beach, CA 90808-2146 | 2016-05-05 |
| 1083079289 | Majestic Medical Clinic, Inc. | Family Medicine | 817 Atlantic Ave # 14, Long Beach, CA 90813-4512 | 2015-12-15 |
| 1336522788 | Duc Nguyen | Family Medicine | 555 E Ocean Blvd Ste 110, Long Beach, CA 90802 | 2015-07-02 |
| 1356781132 | Philip Kim | Family Medicine | 1729 Termino Ave Ste B, Long Beach, CA 90804-2121 | 2013-06-26 |
| 1881932168 | Ronald Merton Sommer | Family Medicine | 1436 W. 23rd St., Westside Free Clinic, Long Beach, CA 90810 | 2013-01-22 |
| 1053693275 | Michael James Miech | Family Medicine | 6301 Marina Pacifica Dr S, Long Beach, CA 90803-3821 | 2011-09-13 |
| Find all providers in LONG BEACH | ||||
| City | LONG BEACH |
| Zip Code | 90802 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.