Healthcare Provider Details

I. General information

NPI: 1386150936
Provider Name (Legal Business Name): MVN 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 MARINE AVE APT 10
GARDENA CA
90247-4168
US

IV. Provider business mailing address

1048 MARINE AVE APT 10
GARDENA CA
90247-4168
US

V. Phone/Fax

Practice location:
  • Phone: 510-283-1329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY LEWIS
Title or Position: COORDINATOR
Credential:
Phone: 510-283-1329