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General NPI Number Information
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NPI Number | 1790901361
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Entity Type | Organization
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Legal Business Name | MC MEDICAL CLINIC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 12100 IMPERIAL HWY SUITE 102
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City | NORWALK
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State | CA
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Zip | 90650-3081
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Country | US
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Telephone | 562-929-4894
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Fax | 562-929-6555
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Provider Business Mailing Address
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Address Line | 12100 IMPERIAL HWY SUITE 102
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City | NORWALK
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State | CA
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Zip | 90650-3081
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Country | US
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Telephone | 562-929-4894
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Fax | 562-929-6555
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MELCHOR COLLANTES
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Credential | M.D.
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Telephone | 562-929-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | A37955
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | A37955
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | A37955
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A37955
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License Number State | CA
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