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MEMORIALCARE MEDICAL GROUP INC. NPI 1710029368


NPI Information

NPI: 1710029368
Provider Name: MEMORIALCARE MEDICAL GROUP, INC.

Doing Business As: MEMORIALCARE MEDICAL GROUP - ALISO VIEJO

Classification: Non-Pharmacy Dispensing Site - 332900000X
Entity Type: Organization

CLIA Number: 05D0581012

Address:
15 MAREBLU
SUITE 100
ALISO VIEJO, CA
ZIP 92656
Phone: (949) 448-0656
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MEMORIALCARE MEDICAL GROUP, INC. is a non pharmacy dispensing site in Aliso Viejo, CA. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) MEMORIALCARE MEDICAL GROUP, INC. NPI is 1710029368. The provider is registered as an organization entity type.
The provider Is Doing Business As Memorialcare Medical Group - Aliso Viejo.

The provider's business location address is:

15 MAREBLU
SUITE 100
ALISO VIEJO, CA
ZIP 92656-015
Phone: (949) 448-0656

The provider's authorized official is Kenny Heine .
The authorized official title is Vp Of Operations and has the following contact phone number (858) 625-2990.

The CLIA number assigned to this NPI record is 05D0581012 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/12/2007 and was last updated on 4/3/2013.


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
1332900000XNon-Pharmacy Dispensing SiteA43924CALIFORNIAYes

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

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