Provider Demographics
NPI:1790068971
Name:MEDICAL CONCIERGE
Entity Type:Organization
Organization Name:MEDICAL CONCIERGE
Other - Org Name:MED-LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-230-5343
Mailing Address - Street 1:647 CAMINO DE LOS MARES STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2860
Mailing Address - Country:US
Mailing Address - Phone:949-230-5343
Mailing Address - Fax:949-489-2569
Practice Address - Street 1:307 E AVENIDA CORDOBA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2314
Practice Address - Country:US
Practice Address - Phone:949-359-8273
Practice Address - Fax:949-943-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30600418323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility