Provider Demographics
NPI:1164159364
Name:CARVAJAL & ALQUIROZ MOBILE PROFESSIONALS INC- A PROFESSIONAL N
Entity Type:Organization
Organization Name:CARVAJAL & ALQUIROZ MOBILE PROFESSIONALS INC- A PROFESSIONAL N
Other - Org Name:MRC MOBILE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-671-0012
Mailing Address - Street 1:121 W LEXINGTON DR STE 303B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2203
Mailing Address - Country:US
Mailing Address - Phone:818-671-0012
Mailing Address - Fax:818-671-5581
Practice Address - Street 1:121 W LEXINGTON DR STE 303B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2203
Practice Address - Country:US
Practice Address - Phone:818-671-0012
Practice Address - Fax:818-671-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty