Healthcare Provider Details

I. General information

NPI: 1790386746
Provider Name (Legal Business Name): MVML, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 N MAIN ST
ORANGE CA
92867-3443
US

IV. Provider business mailing address

300 SPECTRUM CENTER DRIVE SUITE 200
IRVINE CA
92618-4987
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-2020
  • Fax: 714-279-2020
Mailing address:
  • Phone: 951-658-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE AZARRAGA
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 562-215-2811