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Organization
MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.
Active
Organization
MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.
Active
Parent organization
MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.
Other names
San Clemente Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.
Authorized official
DR. SUSAN YVONNE MELVIN D.O. (PRESIDENT/CEO)
(562) 933-0053
Entity
Organization
Contact information
Practice address
450 E SPRING ST, SUITE 1, LONG BEACH, CA 90806-1625
(562) 933-0053
(562) 933-0079
Mailing address
1300 AVENIDA VISTA HERMOSA, SUITE 200, SAN CLEMENTE, CA 92673-6315
(949) 452-3199
(949) 218-6866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A5075
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0071000
—
CA
Enumeration date
06/22/2010
Last updated
06/22/2010
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