Healthcare Provider Details

I. General information

NPI: 1730427436
Provider Name (Legal Business Name): MVM MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST STE 305
LAKEWOOD CA
90805-4549
US

IV. Provider business mailing address

PO BOX 6768
BUENA PARK CA
90622-6768
US

V. Phone/Fax

Practice location:
  • Phone: 562-817-5602
  • Fax: 562-817-5605
Mailing address:
  • Phone: 562-817-5602
  • Fax: 562-817-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIKRAM MARFATIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-756-2400