Provider Demographics
NPI:1528573060
Name:MEDIVAULTZ, LLC.
Entity Type:Organization
Organization Name:MEDIVAULTZ, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-408-5345
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4001
Mailing Address - Country:US
Mailing Address - Phone:213-328-3600
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4001
Practice Address - Country:US
Practice Address - Phone:323-384-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical