Healthcare Provider Details

I. General information

NPI: 1740941921
Provider Name (Legal Business Name): MSK MONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 MINDANAO WAY STE 300
MARINA DEL REY CA
90292-6393
US

IV. Provider business mailing address

13160 MINDANAO WAY STE 300
MARINA DEL REY CA
90292-6393
US

V. Phone/Fax

Practice location:
  • Phone: 281-346-3480
  • Fax: 281-462-4106
Mailing address:
  • Phone: 281-346-3480
  • Fax: 281-462-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARTINEZ
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 281-346-3480