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Organization
MEMRAD MEDICAL GROUP INC
Active
Organization
MEMRAD MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN BROOKS (VICE PRESIDENT, OPERATIONS)
(562) 590-7400
Entity
Organization
Contact information
Practice address
100 OCEANGATE, STE 1000, LONG BEACH, CA 90802
(562) 590-7400
Mailing address
100 OCEANGATE, STE 1000, LONG BEACH, CA 90802
(562) 590-7400
(562) 590-7452
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0023351
MEDI-CAL
—
01
—
GR0023352
MEDI-CAL
—
01
—
GR0023355
MEDI-CAL
—
01
—
GR0023356
MEDI-CAL
—
01
—
GR0023357
MEDI-CAL
—
01
—
GR0023358
MEDI-CAL
—
01
—
GR0023359
MEDI-CAL
—
01
—
ZZZ27107Z
BLUE SHIELD
—
01
—
ZZZ74966Z
MEDI-CAL
—
01
—
ZZZ77516Z
MEDI-CAL
—
Enumeration date
12/02/2005
Last updated
08/22/2020
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