Provider Demographics
NPI:1164896957
Name:MOBILE PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:MOBILE PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:818-335-4443
Mailing Address - Street 1:18302 SIERRA HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-6126
Mailing Address - Country:US
Mailing Address - Phone:818-219-1443
Mailing Address - Fax:661-424-9672
Practice Address - Street 1:18302 SIERRA HWY STE 103
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-6126
Practice Address - Country:US
Practice Address - Phone:818-219-1443
Practice Address - Fax:661-424-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630977163WP0000X, 174H00000X, 253Z00000X, 363L00000X
CA6309977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care