Provider Demographics
NPI:1528390887
Name:MOBILE PHYSICALS
Entity Type:Organization
Organization Name:MOBILE PHYSICALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:JANETH
Authorized Official - Last Name:BUELNA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-272-2334
Mailing Address - Street 1:3057 W VIA CUERVO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6238
Mailing Address - Country:US
Mailing Address - Phone:520-272-2334
Mailing Address - Fax:520-883-0454
Practice Address - Street 1:3057 W VIA CUERVO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6238
Practice Address - Country:US
Practice Address - Phone:520-272-2334
Practice Address - Fax:520-883-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109715251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health