Provider Demographics
NPI:1053126425
Name:MCLV INNOVATION ENTERPRISES INC
Entity type:Organization
Organization Name:MCLV INNOVATION ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUENCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-265-1152
Mailing Address - Street 1:3950 E SUNSET RD STE 116
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4906
Mailing Address - Country:US
Mailing Address - Phone:702-665-5785
Mailing Address - Fax:702-665-6269
Practice Address - Street 1:3950 E SUNSET RD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4906
Practice Address - Country:US
Practice Address - Phone:702-665-5785
Practice Address - Fax:702-665-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy