Healthcare Provider Details

I. General information

NPI: 1457752198
Provider Name (Legal Business Name): MVP PEDIATRIC AND URGENT CARE A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 VENTURA BLVD STE B
TARZANA CA
91356-4101
US

IV. Provider business mailing address

18555 VENTURA BLVD STE B
TARZANA CA
91356-4101
US

V. Phone/Fax

Practice location:
  • Phone: 310-849-4400
  • Fax:
Mailing address:
  • Phone: 310-849-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID EPSTEIN
Title or Position: CEO
Credential: MD
Phone: 310-849-4400