Provider Demographics
NPI:1912541061
Name:MVP MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:MVP MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HONIG MOJICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-860-5305
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-498-6686
Mailing Address - Fax:
Practice Address - Street 1:475 ATLANTIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4383
Practice Address - Country:US
Practice Address - Phone:718-369-4850
Practice Address - Fax:718-369-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty