MEMORIALCARE MEDICAL FOUNDATION NPI 1205167350

NPI Information

  • NPI: 1205167350
  • Provider Name: MEMORIALCARE MEDICAL FOUNDATION
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 05D2191820
  • Address: 17360 BROOKHURST ST
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Phone: (877) 696-3622

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NPI Details

MEMORIALCARE MEDICAL FOUNDATION is a clinic center in Fountain Valley, CA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). MEMORIALCARE MEDICAL FOUNDATION NPI is 1205167350. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

17360 BROOKHURST ST
FOUNTAIN VALLEY, CA
ZIP 92708-720
Phone: (877) 696-3622

The provider's authorized official is Laurie Sicaeros .
The authorized official title is Coo/vp Physician Integration and has the following contact phone number (877) 696-3622.

The CLIA number assigned to this NPI record is 05D2191820 - other - employee health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/28/2010 and was last updated on 2/27/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician AssistantNo
2363L00000XNurse PractitionerNo
3207Q00000XFamily MedicineNo
4207R00000XInternal MedicineNo
5207RG0100XInternal MedicineGastroenterologyNo
6207RR0500XInternal MedicineRheumatologyNo
7207T00000XNeurological SurgeryNo
8207V00000XObstetrics & GynecologyNo
9207XX0005XOrthopaedic SurgerySports MedicineNo
10208000000XPediatricsNo
11208100000XPhysical Medicine & RehabilitationNo
122083X0100XPreventive MedicineOccupational MedicineNo
13208M00000XHospitalistNo
14213E00000XPodiatristNo
15261Q00000XClinic/CenterYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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