Healthcare Provider Details

I. General information

NPI: 1518353606
Provider Name (Legal Business Name): MI HOPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 HALLEY TERRANCE SE
WASHINGTON DC
20032
US

IV. Provider business mailing address

1634 SPRUCE ST
SOUTH PASADENA CA
91030-4719
US

V. Phone/Fax

Practice location:
  • Phone: 213-864-6307
  • Fax:
Mailing address:
  • Phone: 626-616-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number587114966 PMA
License Number StateDC

VIII. Authorized Official

Name: DR. WILLIAM JOHN MARTIN
Title or Position: DIRECTOR/FOUNDER
Credential: MD
Phone: 626-616-2868