Healthcare Provider Details

I. General information

NPI: 1669650792
Provider Name (Legal Business Name): MEMORIA HOSPITAL OF GARDENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3528
US

IV. Provider business mailing address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3528
US

V. Phone/Fax

Practice location:
  • Phone: 310-512-6169
  • Fax: 310-512-6126
Mailing address:
  • Phone: 310-512-6169
  • Fax: 310-512-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE POPKINS
Title or Position: CEO
Credential:
Phone: 310-512-6204