Provider Demographics
NPI:1578010757
Name:MEDI WEIGHTLOSS SOUTH BAY AND TORRANCE
Entity Type:Organization
Organization Name:MEDI WEIGHTLOSS SOUTH BAY AND TORRANCE
Other - Org Name:MV MEDICAL CONSULTANTS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLPICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-504-1622
Mailing Address - Street 1:904 SILVER SPUR RD
Mailing Address - Street 2:497
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3800
Mailing Address - Country:US
Mailing Address - Phone:310-504-1622
Mailing Address - Fax:424-271-9248
Practice Address - Street 1:3828 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2408
Practice Address - Country:US
Practice Address - Phone:310-504-1622
Practice Address - Fax:424-271-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59030Medicare UPIN