Healthcare Provider Details

I. General information

NPI: 1992850150
Provider Name (Legal Business Name): HELENA MBA MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6485 DAY ST SUITE #203
RIVERSIDE CA
92507-0929
US

IV. Provider business mailing address

655 S FLOWER ST SUITE #334
LOS ANGELES CA
90017-2805
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5800
  • Fax: 951-697-5801
Mailing address:
  • Phone: 310-462-0181
  • Fax: 213-892-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HELENA O. MBA
Title or Position: DIRECTOR
Credential: MD
Phone: 310-462-0181