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General NPI Number Information
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NPI Number | 1528122389
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Entity Type | Organization
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Legal Business Name | MEMORIAL MARITIME CLINIC, INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 S PICO AVE
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City | LONG BEACH
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State | CA
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Zip | 90802
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Country | US
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Telephone | 562-432-2820
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Fax | 562-437-1353
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Provider Business Mailing Address
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Address Line | 150 S PICO AVE
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City | LONG BEACH
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State | CA
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Zip | 90802
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Country | US
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Telephone | 562-432-2821
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Fax | 562-437-1353
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK PEREZ
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Credential | MD
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Telephone | 562-432-2821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G067514
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License Number State | CA
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