Provider Demographics
NPI:1689425514
Name:MMG TEAM
Entity Type:Organization
Organization Name:MMG TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANANYAN-GYULBEKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-0301
Mailing Address - Street 1:6727 ODESSA AVE # 201
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5747
Mailing Address - Country:US
Mailing Address - Phone:747-264-0301
Mailing Address - Fax:747-217-4318
Practice Address - Street 1:6727 ODESSA AVE # 201
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-5747
Practice Address - Country:US
Practice Address - Phone:747-264-0301
Practice Address - Fax:747-217-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy