Provider Demographics
NPI:1699320382
Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:MQVN COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-255-8665
Mailing Address - Street 1:13085 CHEF MENTEUR HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-1804
Mailing Address - Country:US
Mailing Address - Phone:504-255-8665
Mailing Address - Fax:504-254-6447
Practice Address - Street 1:13101 CHEF MENTEUR HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-1806
Practice Address - Country:US
Practice Address - Phone:504-281-4461
Practice Address - Fax:504-254-6447
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MQVN COMMUNITY DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty