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General NPI Number Information
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NPI Number | 1912541061
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Entity Type | Organization
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Legal Business Name | MVP MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 475 ATLANTIC AVE STE 2
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City | BROOKLYN
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State | NY
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Zip | 11217-4383
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Country | US
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Telephone | 718-369-4850
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Fax | 718-369-4851
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-498-6686
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LYLE HONIG MOJICA
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Credential |
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Telephone | 323-860-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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