Healthcare Provider Details

I. General information

NPI: 1023298312
Provider Name (Legal Business Name): MEMORIAL CARDIOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2898 LINDEN AVE
LONG BEACH CA
90806-1627
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-2000
  • Fax:
Mailing address:
  • Phone: 562-595-8671
  • Fax: 562-490-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberBU95033110
License Number StateCA

VIII. Authorized Official

Name: DR. SERGE M TOBIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-595-8671