Healthcare Provider Details

I. General information

NPI: 1275823130
Provider Name (Legal Business Name): MVP FAMILY PRACTICE & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 FLORENCE AVE
DOWNEY CA
90240-3728
US

IV. Provider business mailing address

7800 FLORENCE AVE
DOWNEY CA
90240-3728
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-5700
  • Fax: 562-928-5707
Mailing address:
  • Phone: 562-928-5700
  • Fax: 562-928-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA67059
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA67059
License Number StateCA

VIII. Authorized Official

Name: BRIAN C PAYNE
Title or Position: DIRECTOR
Credential: MD
Phone: 562-928-5700