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Organization
MEMORIAL MARITIME CLINIC, INC.
Active
Organization
MEMORIAL MARITIME CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK PEREZ MD (OWNER)
(562) 432-2821
Entity
Organization
Contact information
Practice address
150 S PICO AVE, LONG BEACH, CA 90802
(562) 432-2820
(562) 437-1353
Mailing address
150 S PICO AVE, LONG BEACH, CA 90802
(562) 432-2821
(562) 437-1353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G067514
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G675140
BLUE SHIELD OF CA
CA
05
—
G00675140
—
CA
01
—
G67514
MED LICENSE
CA
Enumeration date
12/19/2006
Last updated
08/22/2020
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