Provider Demographics
NPI:1396159778
Name:MMI MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MMI MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARIETTE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AROUTIOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-236-4709
Mailing Address - Street 1:8447 WILSHIRE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-861-8159
Practice Address - Street 1:2080 CENTURY PARK E STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2010
Practice Address - Country:US
Practice Address - Phone:310-715-3237
Practice Address - Fax:310-861-8159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMI MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-13
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78454332900000X
261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332900000XSuppliersNon-Pharmacy Dispensing Site