Provider Demographics
NPI:1376323782
Name:RL MOBILE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:RL MOBILE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:RIZA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:714-603-6035
Mailing Address - Street 1:6655 W SAHARA AVE STE D110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0846
Mailing Address - Country:US
Mailing Address - Phone:714-603-6035
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE STE D110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0846
Practice Address - Country:US
Practice Address - Phone:725-201-1440
Practice Address - Fax:725-021-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty