Healthcare Provider Details

I. General information

NPI: 1922116920
Provider Name (Legal Business Name): MP MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6559 EDMONTON AVE
SAN DIEGO CA
92122-2514
US

IV. Provider business mailing address

6559 EDMONTON AVE
SAN DIEGO CA
92122-2514
US

V. Phone/Fax

Practice location:
  • Phone: 858-449-0131
  • Fax: 858-866-0688
Mailing address:
  • Phone: 858-449-0131
  • Fax: 858-866-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number101308
License Number StateCA

VIII. Authorized Official

Name: MS. MADELYN C PHILLIPS
Title or Position: PRESIDENT MP MEDICAL INC
Credential:
Phone: 858-449-0131