Healthcare Provider Details

I. General information

NPI: 1619803889
Provider Name (Legal Business Name): MP WELLNESS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 190TH ST
REDONDO BEACH CA
90278-5344
US

IV. Provider business mailing address

2615 190TH ST
REDONDO BEACH CA
90278-5344
US

V. Phone/Fax

Practice location:
  • Phone: 310-953-5009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MADDISON PAUL
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 310-953-5009