Healthcare Provider Details

I. General information

NPI: 1497373237
Provider Name (Legal Business Name): MVP NEPHROLOGY DIALYSIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 VAN NUYS BLVD
SHERMAN OAKS CA
91403-1716
US

IV. Provider business mailing address

501 W GLENOAKS BLVD STE 341
GLENDALE CA
91202-2896
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: NIMA RABBANI
Title or Position: CFO
Credential: DO
Phone: 818-259-4724