Provider Demographics
NPI:1053782441
Name:MBM PLUS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MBM PLUS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNIC
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:818-378-9549
Mailing Address - Street 1:8252 SETTLERS INN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-4872
Mailing Address - Country:US
Mailing Address - Phone:818-378-9549
Mailing Address - Fax:
Practice Address - Street 1:8252 SETTLERS INN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-4872
Practice Address - Country:US
Practice Address - Phone:818-378-9549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2044828OtherCLIA
CA572011OtherBCBSF