Provider Demographics
NPI:1568647725
Name:MOBILE CARE SERVICES, INC
Entity Type:Organization
Organization Name:MOBILE CARE SERVICES, INC
Other - Org Name:MOBILE CARE SERVICES AND MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:DUGADUGA
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-663-7002
Mailing Address - Street 1:1280 E COOLEY DR
Mailing Address - Street 2:SUITE 29
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3932
Mailing Address - Country:US
Mailing Address - Phone:909-783-6597
Mailing Address - Fax:909-514-1812
Practice Address - Street 1:1280 E COOLEY DR
Practice Address - Street 2:SUITE 29
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3932
Practice Address - Country:US
Practice Address - Phone:909-783-6597
Practice Address - Fax:909-514-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56414261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care