Healthcare Provider Details

I. General information

NPI: 1033127253
Provider Name (Legal Business Name): MEMORIAL HEALTHCARE IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHERRY AVE SUITE #250
SIGNAL HILL CA
90755-2051
US

IV. Provider business mailing address

2525 CHERRY AVE SUITE #250
SIGNAL HILL CA
90755-2051
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-9500
  • Fax: 562-981-9521
Mailing address:
  • Phone: 562-981-9500
  • Fax: 562-981-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberC208621
License Number StateCA

VIII. Authorized Official

Name: MRS. CATHY GIES
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 562-981-9500