Healthcare Provider Details

I. General information

NPI: 1083797450
Provider Name (Legal Business Name): MGV HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 MURPHY CANYON RD C-202
SAN DIEGO CA
92123-4498
US

IV. Provider business mailing address

3944 MURPHY CANYON RD STE C202
SAN DIEGO CA
92123-4427
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-6837
  • Fax: 858-373-8917
Mailing address:
  • Phone: 858-573-6837
  • Fax: 858-573-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number058091
License Number StateCA

VIII. Authorized Official

Name: MRS. HAZEL ANN ASUNCION HERNANDEZ
Title or Position: DOPCS
Credential: RN
Phone: 858-573-6837