1629642921 NPI number — MOBILE CARE MEDICAL GROUP, INC

Table of content: (NPI 1629642921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629642921 NPI number — MOBILE CARE MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE CARE MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629642921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E ROUTE 66 STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91740-6360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-567-4520
Provider Business Mailing Address Fax Number:
213-567-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 SMITH ST UNIT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94587-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-261-4978
Provider Business Practice Location Address Fax Number:
818-471-4287
Provider Enumeration Date:
05/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALAMAT
Authorized Official First Name:
MARLON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
626-497-6500

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NONE . This is a "NONE" identifier . This identifiers is of the category "OTHER".