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General NPI Number Information
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NPI Number | 1376729772
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Entity Type | Individual
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Provider Name | MAA VILI
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Gender | Male
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 2043 242ND ST
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City | LOMITA
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State | CA
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Zip | 90717-1115
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Country | US
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Telephone | 424-263-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 340 E 229TH PL
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City | CARSON
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State | CA
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Zip | 90745-4908
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Country | US
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Telephone | 310-522-1064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | N9429567
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License Number State | CA
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