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Organization
MODERN TELEHEALTH
Active
Organization
MODERN TELEHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PAYNE (CEO)
(361) 739-6806
Entity
Organization
Contact information
Practice address
1509 ESPINOSA CIR, PALOS VERDES ESTATES, CA 90274-1917
(361) 739-6806
Mailing address
1509 ESPINOSA CIR, PALOS VERDES ESTATES, CA 90274-1917
(361) 739-6806
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3617396806
THIS IS THE INITIAL EFFORT
—
01
—
NA
NA
—
Enumeration date
09/12/2020
Last updated
09/12/2020
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