Basic Information
| Provider Information | |||||||||
| NPI: | 1023298312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL CARDIOLOGY MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2898 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625958671 | ||||||||
| FaxNumber: | 5624902015 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629332000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | TOBIAS | ||||||||
| AuthorizedOfficialFirstName: | SERGE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5625958671 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | BU95033110 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Legal Medicine |
No ID Information.