Provider Demographics
NPI:1093059180
Name:MVP FAMILY PRACTICE & SPORTS MEDICINE, INC
Entity Type:Organization
Organization Name:MVP FAMILY PRACTICE & SPORTS MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:CASTELLON
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:562-923-4687
Mailing Address - Street 1:8207 3RD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3731
Mailing Address - Country:US
Mailing Address - Phone:562-923-4687
Mailing Address - Fax:562-923-4688
Practice Address - Street 1:8207 3RD ST STE 205
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3731
Practice Address - Country:US
Practice Address - Phone:562-923-4687
Practice Address - Fax:562-923-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty