Provider Demographics
NPI:1730427436
Name:MVM MEDICAL CORPORATION
Entity type:Organization
Organization Name:MVM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARFATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-756-2400
Mailing Address - Street 1:PO BOX 6768
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622-6768
Mailing Address - Country:US
Mailing Address - Phone:562-817-5602
Mailing Address - Fax:562-817-5605
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:STE 305
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-817-5602
Practice Address - Fax:562-817-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty