Healthcare Provider Details

I. General information

NPI: 1023439627
Provider Name (Legal Business Name): MVML, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 SAINT JOHN PL
HEMET CA
92543-4421
US

IV. Provider business mailing address

945 SAINT JOHN PL
HEMET CA
92543-4421
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-1400
  • Fax: 951-658-1411
Mailing address:
  • Phone: 951-658-1400
  • Fax: 951-658-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF 00345267
License Number StateCA

VIII. Authorized Official

Name: MATTHEW COLLINS
Title or Position: PRESIDENT, CFO, AND SECRETARY
Credential:
Phone: 949-791-7881