1790386746 NPI number — MVML, INC.

Table of content: (NPI 1790386746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790386746 NPI number — MVML, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MVML, INC.
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:
1790386746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SPECTRUM CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-4987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-658-1400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1594 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92867-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-974-2020
Provider Business Practice Location Address Fax Number:
714-279-2020
Provider Enumeration Date:
11/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
AZARRAGA
Authorized Official First Name:
KRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
562-215-2811

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CDF-900001870 . This is a "DEPT. OF HEALTH SERV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 40965 . This is a "PA DEPT. OF HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3907 . This is a "MARYLAND DEPT. OF HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LCO01741 . This is a "DEPT. OF HEALTH - CENTER FOR HEALTH FACILITIES REGULATION" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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