Provider Demographics
NPI:1992271597
Name:TRINITY MEDICAL CARE
Entity type:Organization
Organization Name:TRINITY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELEMELEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-310-1795
Mailing Address - Street 1:5200 CLARK AVE UNIT 768
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-7037
Mailing Address - Country:US
Mailing Address - Phone:562-531-6140
Mailing Address - Fax:562-531-7404
Practice Address - Street 1:3650 SOUTH ST STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1534
Practice Address - Country:US
Practice Address - Phone:562-531-6140
Practice Address - Fax:562-531-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649414855Medicaid