Provider Demographics
NPI:1144778440
Name:TOTAL CARE MOBILE MEDICAL UNIT
Entity Type:Organization
Organization Name:TOTAL CARE MOBILE MEDICAL UNIT
Other - Org Name:TOTAL CARE MEDICAL CLINIC LNC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-756-1412
Mailing Address - Street 1:10024 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3112
Mailing Address - Country:US
Mailing Address - Phone:323-756-1412
Mailing Address - Fax:323-756-1413
Practice Address - Street 1:10024 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3112
Practice Address - Country:US
Practice Address - Phone:323-756-1412
Practice Address - Fax:323-756-1413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL CARE MEDICAL CLINIC LNC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002631170100000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002631Medicaid
CA550002631Medicaid