Healthcare Provider Details

I. General information

NPI: 1831173905
Provider Name (Legal Business Name): MEMRAD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OCEANGATE STE 1000
LONG BEACH CA
90802
US

IV. Provider business mailing address

100 OCEANGATE STE 1000
LONG BEACH CA
90802
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-7400
  • Fax:
Mailing address:
  • Phone: 562-590-7400
  • Fax: 562-590-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN BROOKS
Title or Position: VICE PRESIDENT, OPERATIONS
Credential:
Phone: 562-590-7400