Basic Information
| Provider Information | |||||||||
| NPI: | 1497373237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MVP NEPHROLOGY DIALYSIS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 W GLENOAKS BLVD STE 341 | ||||||||
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| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912022896 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4911 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189817111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | RABBANI | ||||||||
| AuthorizedOfficialFirstName: | NIMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8182594724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.