San Clemente Family Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SAN CLEMENTE FAMILY MEDICINE

Practice address

1300 Avenida Vista Hermosa
Suite 200
San Clemente, CA 92673-6315

Phone

(949) 452-3199

Fax

(949) 218-6866

NPI assigned

Jun 21, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susan Yvonne Melvin, D.O.NPI 1750487765

Title

President/Ceo

Phone

(562) 933-0055

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Memorial Family Medicine Medical Group, Inc. Doing business as

Tax ID family

Memorial Famil Y M2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Memorial Family Medicine Medical Group, Inc.

  • Family Medicine Physician
  • Long Beach, CA
  • NPI 1922329127
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Melvin, D.O.

  • Adolescent Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1750487765
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277078400000",
    "number": "1154642452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E SPRING ST",
            "address_2": "SUITE 1",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061625",
            "telephone_number": "562-933-0053",
            "fax_number": "562-933-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 AVENIDA VISTA HERMOSA",
            "address_2": "SUITE 200",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736315",
            "telephone_number": "949-452-3199",
            "fax_number": "949-218-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN CLEMENTE FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-21",
        "last_updated": "2010-06-21",
        "status": "A",
        "authorized_official_last_name": "MELVIN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "562-933-0055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Family Medicine Medical Group, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Danielle Salomone, PTA
• Ronald Stanley Saltzman, MD
• Nicholas C Salvati, DMD
• Darush Behzad Samia, R.N.F.A.
• San Clemente Diagnostic Medical Clinic
• San Clemente Internal Medical Group Inc.
• San Clemente Optometry Corp
• San Clemente Physical Therapy Inc
• San Clemente Vitality Center Inc.
• Alma C Sanchez, M.D.

• Family Medicine Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.