=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093254377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MPR HEALTH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2017
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10362 GREENWOOD CT CUPERTINO, CA 95014 SUITE #2
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-279-1473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10362 GREENWOOD CT CUPERTINO, CA 95014 SUITE #2
-----------------------------------------------------
City | CUPERTINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-279-1473
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O/OWNER
-----------------------------------------------------
Name | DR. KAREEM HUBBARD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 202-279-1473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | A128252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------