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General NPI Number Information
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NPI Number | 1356980494
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Entity Type | Organization
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Legal Business Name | MEMORY SPA, LLC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 1950 SUNNY CREST DR STE 1400
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City | FULLERTON
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State | CA
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Zip | 92835-3642
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Country | US
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Telephone | 714-706-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 SUNNY CREST DR STE 1400
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City | FULLERTON
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State | CA
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Zip | 92835-3642
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Country | US
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Telephone | 714-706-4253
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BRYAN D. REAMER-YU
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Credential | MBA
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Telephone | 714-706-4253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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