1215372214 NPI number — MLC FINANCIAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215372214 NPI number — MLC FINANCIAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MLC FINANCIAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215372214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8027 CAMELLIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23518-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-275-9548
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3175 AZALEA GARDEN RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23513-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-275-9548
Provider Business Practice Location Address Fax Number:
757-583-5082
Provider Enumeration Date:
05/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
MACHEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-544-0825

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)