=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922116920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MP MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 01/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6559 EDMONTON AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-449-0131
-----------------------------------------------------
Fax | 858-866-0688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6559 EDMONTON AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-2514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-449-0131
-----------------------------------------------------
Fax | 858-866-0688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT MP MEDICAL INC
-----------------------------------------------------
Name | MS. MADELYN C PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-449-0131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 101308
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------