Provider Demographics
NPI:1366672099
Name:MPN, MEDICAL PROVIDERS GROUP, INC.
Entity Type:Organization
Organization Name:MPN, MEDICAL PROVIDERS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-399-0596
Mailing Address - Street 1:235 VERBENA LN
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-7055
Mailing Address - Country:US
Mailing Address - Phone:714-392-6905
Mailing Address - Fax:714-528-9846
Practice Address - Street 1:1811 E CENTER ST
Practice Address - Street 2:210
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3401
Practice Address - Country:US
Practice Address - Phone:714-399-0596
Practice Address - Fax:714-399-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34005208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty