Provider Demographics
NPI:1174252951
Name:MQM MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MQM MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-997-9105
Mailing Address - Street 1:5682 DAWN FALLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7650
Mailing Address - Country:US
Mailing Address - Phone:858-997-9105
Mailing Address - Fax:
Practice Address - Street 1:12826 VICTORY BLVD STE E
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3065
Practice Address - Country:US
Practice Address - Phone:818-583-0055
Practice Address - Fax:818-583-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty