Organization
MC MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELCHOR COLLANTES M.D. (DOCTOR)
(562) 929-4894
Entity
Organization
Contact information
Practice address
12100 IMPERIAL HWY, SUITE 102, NORWALK, CA 90650-3081
(562) 929-4894
(562) 929-6555
Mailing address
12100 IMPERIAL HWY, SUITE 102, NORWALK, CA 90650-3081
(562) 929-4894
(562) 929-6555
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A37955
CA
302R00000X
Health Maintenance Organization
A37955
CA
305R00000X
Preferred Provider Organization
A37955
CA
305S00000X
Point of Service
A37955
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N96343
BLUE CROSS PCP
CA
Enumeration date
04/18/2007
Last updated
09/11/2025
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