Provider Demographics
NPI:1538493044
Name:MWP MEDICAL CLINIC
Entity Type:Organization
Organization Name:MWP MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:PIATKOWSKI-NAZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-437-3986
Mailing Address - Street 1:11755 VICTORY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:626-437-3986
Mailing Address - Fax:
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:626-437-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30385208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty