Provider Demographics
NPI:1609597152
Name:MOBILE CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MOBILE CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-300-7541
Mailing Address - Street 1:2975 S RAINBOW BLVD STE E3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6218
Mailing Address - Country:US
Mailing Address - Phone:702-529-0058
Mailing Address - Fax:
Practice Address - Street 1:2975 S RAINBOW BLVD STE E3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6218
Practice Address - Country:US
Practice Address - Phone:702-529-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care