Provider Demographics
NPI:1306215454
Name:HOUSE CALL MOBILE CLINIC, LLC
Entity Type:Organization
Organization Name:HOUSE CALL MOBILE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-665-4437
Mailing Address - Street 1:1500 SAN REMO AVE STE 251
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3012
Mailing Address - Country:US
Mailing Address - Phone:305-665-4437
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN REMO AVE STE 251
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3012
Practice Address - Country:US
Practice Address - Phone:305-665-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty