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NPI Code Detail

MEDICARE: MEMORIALCARE MEDICAL GROUP, INC.

MEDICARE: MEMORIALCARE MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing SiteA31048CA

General Provider Information

NPI Number : 1194866772
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIALCARE MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number : 858-625-2990
Fax Number :
Provider Business Practice Location Address
First Line : 26991 CROWN VALLEY PKWY
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-6528
Country : US
Telephone Number : 949-582-2002
Fax Number :
Authorized Official
Title or Position : VP OF OPERATIONS
Name : MR. KENNY HEINE
Credential :
Telephone Number : 858-625-2990
Provider Enumeration Date : 02/08/2007
Last Update Date : 04/03/2013

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Directions to “MEMORIALCARE MEDICAL GROUP, INC. ” Practice Location

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