Provider Demographics
NPI:1255313698
Name:SUPERIOR MOBILITY, INC.
Entity Type:Organization
Organization Name:SUPERIOR MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-755-6480
Mailing Address - Street 1:1950 E 220TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1649
Mailing Address - Country:US
Mailing Address - Phone:310-218-2040
Mailing Address - Fax:310-218-2034
Practice Address - Street 1:1950 E 220TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1649
Practice Address - Country:US
Practice Address - Phone:310-218-2040
Practice Address - Fax:310-218-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77465332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78492ZMedicaid
CAZZZ78492ZMedicaid