Provider Type Icon

MMGL LLC NPI 1093984171


NPI Information

NPI: 1093984171
Provider Name: MMGL, LLC

Doing Business As: FIVE STAR MEDICAL CLINIC

Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization

CLIA Number: 03D2068332

Address:
2175 N. ALMA SCHOOL RD.
SUITE A- 104
CHANDLER, AZ
ZIP 85224
Phone: (480) 275-4415
Get Directions

MMGL, LLC is a preferred provider organization in Chandler, AZ. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. MMGL, LLC NPI is 1093984171. The provider is registered as an organization entity type.
The provider Is Doing Business As Five Star Medical Clinic.

The provider's business location address is:

2175 N. ALMA SCHOOL RD.
SUITE A- 104
CHANDLER, AZ
ZIP 85224
Phone: (480) 275-4415
Fax: (480) 275-4577

The provider's authorized official is Maria Manuela Gonzalez-landestoy .
The authorized official title is Owner/physician and has the following contact phone number (480) 275-4415.

The CLIA number assigned to this NPI record is 03D2068332 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/22/2008 and was last updated on 2/19/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider Organization29719ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Z78260OTHERARIZONAMEDICARE GROUP NUMBER
2632697MEDICAIDARIZONA
30744170OTHERARIZONAAZ BC/BS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.