Healthcare Provider Details

I. General information

NPI: 1407259054
Provider Name (Legal Business Name): MBM PLUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 11/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W MAGNOLIA BLVD
BURBANK CA
91506-1706
US

IV. Provider business mailing address

PO BOX 50005
STUDIO CITY CA
91614-5001
US

V. Phone/Fax

Practice location:
  • Phone: 323-370-5006
  • Fax: 888-872-4399
Mailing address:
  • Phone: 323-370-5006
  • Fax: 888-872-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC27463
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9097
License Number StateCA

VIII. Authorized Official

Name: NATALYA NI MELNIC
Title or Position: OWNER
Credential: RCM
Phone: 323-370-5006