Provider Type Icon

MEMORIALCARE MEDICAL FOUNDATION NPI 1205167350


NPI Information

NPI: 1205167350
Provider Name: MEMORIALCARE MEDICAL FOUNDATION
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 05D0581609

Address:
17360 BROOKHURST ST
FOUNTAIN VALLEY, CA
ZIP 92708
Phone: (714) 377-2900
Get Directions

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: (714) 377-2900

The provider's authorized official is Laurie Sicaeros .
The authorized official title is Coo/vp Physician Integration and has the following contact phone number (714) 377-2900.

The CLIA number assigned to this NPI record is 05D0581609 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/28/2010 and was last updated on 10/31/2019.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineNo
2207R00000XInternal MedicineNo
3207RG0100XInternal MedicineGastroenterologyNo
4207RR0500XInternal MedicineRheumatologyNo
5207T00000XNeurological SurgeryNo
6207V00000XObstetrics & GynecologyNo
7207XX0005XOrthopaedic SurgerySports MedicineNo
8208000000XPediatricsNo
9208100000XPhysical Medicine & RehabilitationNo
102083X0100XPreventive MedicineOccupational MedicineNo
11208M00000XHospitalistNo
12213E00000XPodiatristNo
13363A00000XPhysician AssistantNo
14363L00000XNurse PractitionerNo
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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.