Provider Demographics
NPI:1164899209
Name:MPET INC
Entity Type:Organization
Organization Name:MPET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM LAC PHD
Authorized Official - Phone:408-710-6298
Mailing Address - Street 1:50 E MAIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3661
Mailing Address - Country:US
Mailing Address - Phone:408-782-8500
Mailing Address - Fax:408-782-5199
Practice Address - Street 1:50 E MAIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3661
Practice Address - Country:US
Practice Address - Phone:408-782-8500
Practice Address - Fax:408-782-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14998171100000X
CAAC15353173C00000X
CAA96792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty