MC MEDICAL CLINIC (NPI# 1790901361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790901361 |
| Entity Type | Organization |
| Organization Name | MC MEDICAL CLINIC |
| Practice Address |
12100 Imperial Hwy Suite 102 Norwalk CA 90650-3081 |
| Practice Telephone | 5629294894 |
| Practice Fax Number | 5629296555 |
| Mailing Telephone | 5629294894 |
| Mailing Fax Number | 5629296555 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MELCHOR COLLANTES (DOCTOR) |
| Authorized Official Telephone | 5629294894 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 261QP2300X |
Clinic/Center Specialization: Primary Care |
A37955 | CA | Ambulatory Health Care Facilities |
| X | 302R00000X | Health Maintenance Organization | A37955 | CA | Managed Care Organizations |
| X | 305R00000X | Preferred Provider Organization | A37955 | CA | Managed Care Organizations |
| X | 305S00000X | Point of Service | A37955 | CA | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE CROSS PCP | N96343 | 01 |
| Street Address |
12100 IMPERIAL HWY SUITE 102 |
| City | NORWALK |
| State | CA |
| Zip Code | 90650-3081 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134161078 | Loan T. Tran | Ophthalmology | 12100 Imperial Hwy, 102, Norwalk, CA 90650-4107 | 2006-06-12 |
| 1124252499 | Pacific Care Home Health Agency, Inc. | Home Health | 12100 Imperial Hwy, Suite 209, Norwalk, CA 90650-3081 | 2009-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420316 | Ricky Chavez | Occupational Therapist | 13603 Halcourt Avenue, Norwalk, CA 90650 | 2020-09-03 |
| 1326671652 | Ryan Ly | Psychologist | 11400 Bloomfield Blvd, Norwalk, CA 90650 | 2020-02-14 |
| 1710416177 | Ricky O Lee | Pharmacist | 11401 S. Bloomfield Ave, Norwalk, CA 90650 | 2017-06-08 |
| 1689108847 | Eliana Segura | Student in an Organized Health Care Education/Training Program | 12440 Firestone Ave Blvd., 3020, Norwalk, CA 90650 | 2017-04-14 |
| 1396282752 | Martin Sanchez Torres | Specialist/Technologist, Other | 14003 Summer Ave, Norwalk, CA 90650 | 2017-01-24 |
| 1952859837 | Fatimah Busran | Social Worker | 11401 South Bloomfield Avde., Norwalk, CA 90650 | 2016-09-20 |
| 1760939383 | Andy Chang | Licensed Psychiatric Technician | 12440 East Imperial Highway, Suite 116, Norwalk, CA 90650 | 2016-09-01 |
| 1548634322 | Leslie Yesenia Lazo | Student in an Organized Health Care Education/Training Program | 12440 E. Firestone Blvd, Norwalk, CA 90650 | 2015-11-17 |
| 1306247994 | Ruth Vergara | Student in an Organized Health Care Education/Training Program | 21520 S. Pioneer Blvd., Suite 110, Hawaiian Gardens, CA 90650 | 2014-09-15 |
| 1265854251 | Sungmin Yee | Acupuncturist | 12706 Bloomfield Ave, Apt. 135, Norwalk, CA 90650 | 2014-01-10 |
| Find all providers in zip 90650 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558716464 | Syed H Reza, Md P.C. | Clinic/Center | 346 Main Ave, Suite B, Norwalk, CT 06851-1592 | 2016-04-28 |
| 1659782134 | Angela Wilson | Clinic/Center | 761 Main Ave, Norwalk, CT 06851-1080 | 2014-05-18 |
| 1255583647 | Ramil Mansourov, LLC | Clinic/Center | 235 Main St, Norwalk, CT 06851-2720 | 2008-10-16 |
| 1174642086 | Americares Free Clinic of Norwalk | Clinic/Center | 98 S Main St, Norwalk, CT 06854-3126 | 2007-03-29 |
| 1619093523 | Connecticut Counseling Centers, Inc. | Clinic/Center | 20 N Main St, Norwalk, CT 06854-2656 | 2007-03-22 |
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| 1275131765 | Uzoma Uwakah | Clinic/Center | 2521 Seminary Ave # 1, Oakland, CA 94605-1307 | 2020-10-15 |
| 1508464470 | Pestle Health LLC | Clinic/Center | 550 Gene Friend Way Apt 214, San Francisco, CA 94158-2283 | 2020-10-13 |
| 1902404247 | Arbol Acupuncture | Clinic/Center | 2620 Foothill Blvd Ste A, La Crescenta, CA 91214-4509 | 2020-10-09 |
| 1346857802 | Sos Environmental Health | Clinic/Center | 59 Estaban Dr, Camarillo, CA 93010-1609 | 2020-09-29 |
| 1457966442 | Carlos A. Alvarez., Md., Inc | Clinic/Center | 6001 Truxtun Ave Ste 220, Bakersfield, CA 93309-0662 | 2020-09-15 |
| 1265046395 | Riverway Medical Group A Medical Corporation | Clinic/Center | 1827 S Court St Ste B, Visalia, CA 93277-5469 | 2020-09-05 |
| 1386258754 | Apollo Health Services Inc | Clinic/Center | 438 E Katella Ave Ste 229, Orange, CA 92867-4803 | 2020-09-03 |
| 1538772843 | Unlimited Urgent Care Inc. | Clinic/Center | 8781 Van Nuys Blvd Ste A, Panorama City, CA 91402-2401 | 2020-08-26 |
| Find all providers with the same taxonomy | ||||
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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.