Healthcare Provider Details

I. General information

NPI: 1093059180
Provider Name (Legal Business Name): MVP FAMILY PRACTICE & SPORTS MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 3RD ST STE 205
DOWNEY CA
90241-3731
US

IV. Provider business mailing address

8207 3RD ST STE 205
DOWNEY CA
90241-3731
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4687
  • Fax: 562-923-4688
Mailing address:
  • Phone: 562-923-4687
  • Fax: 562-923-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA67059
License Number StateCA

VIII. Authorized Official

Name: MR. RAMON CASTELLON GONZALEZ
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 562-923-4687