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NPI Code Detail

MEDICARE: MEMORIAL CARDIOLOGY MEDICAL GROUP, INC

MEDICARE: MEMORIAL CARDIOLOGY 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
1174400000XSpecialistG13545CA

General Provider Information

NPI Number : 1720126105
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL CARDIOLOGY MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 2898 LINDEN AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-1627
Country : US
Telephone Number : 562-595-8671
Fax Number : 562-989-0999
Provider Business Practice Location Address
First Line : 2898 LINDEN AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-1627
Country : US
Telephone Number : 562-595-8671
Fax Number : 562-989-0999
Authorized Official
Title or Position : PRESIDENT
Name : DR. ALAN J HERMER
Credential : M.D
Telephone Number : 562-595-8671
Provider Enumeration Date : 02/01/2007
Last Update Date : 08/22/2020

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