Healthcare Provider Details

I. General information

NPI: 1093254377
Provider Name (Legal Business Name): MPR HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 08/25/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10362 GREENWOOD CT CUPERTINO, CA 95014 SUITE #2
CUPERTINO CA
95014
US

IV. Provider business mailing address

10362 GREENWOOD CT CUPERTINO, CA 95014 SUITE #2
CUPERTINO CA
95014
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1473
  • Fax:
Mailing address:
  • Phone: 202-279-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA128252
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREEM HUBBARD
Title or Position: C.E.O/OWNER
Credential: M.D.
Phone: 202-279-1473