Provider Demographics
NPI:1598483620
Name:MOBILE PICC NURSING INC
Entity Type:Organization
Organization Name:MOBILE PICC NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRIAN
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:SITORUS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:909-954-8623
Mailing Address - Street 1:1214 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4919
Mailing Address - Country:US
Mailing Address - Phone:909-922-3112
Mailing Address - Fax:
Practice Address - Street 1:1214 HEATH ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4919
Practice Address - Country:US
Practice Address - Phone:909-922-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty