Provider Demographics
NPI:1558120436
Name:MOBILE MEDICAL TEAM INTERNATIONAL
Entity Type:Organization
Organization Name:MOBILE MEDICAL TEAM INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYNIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-296-0495
Mailing Address - Street 1:111 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2526
Mailing Address - Country:US
Mailing Address - Phone:415-332-2600
Mailing Address - Fax:415-332-2610
Practice Address - Street 1:2603 ELECTRIC AVE STE C
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:415-332-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care