Provider Demographics
NPI:1083061626
Name:MOBILE MEDICAL LA LLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL LA LLC
Other - Org Name:MOBILE MEDICAL LA LLC HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEFIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-507-4305
Mailing Address - Street 1:6818 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-7272
Mailing Address - Country:US
Mailing Address - Phone:310-645-9009
Mailing Address - Fax:310-943-2355
Practice Address - Street 1:6818 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-7272
Practice Address - Country:US
Practice Address - Phone:310-645-9009
Practice Address - Fax:310-943-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health