Provider Demographics
NPI:1093254377
Name:MPR HEALTH GROUP
Entity Type:Organization
Organization Name:MPR HEALTH GROUP
Other - Org Name:MANNIE JOEL, M.D. AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-279-1473
Mailing Address - Street 1:10362 GREENWOOD CT CUPERTINO, CA 95014
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:202-279-1473
Mailing Address - Fax:
Practice Address - Street 1:10362 GREENWOOD CT CUPERTINO, CA 95014
Practice Address - Street 2:SUITE #2
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:202-279-1473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1282522081P2900X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty