Provider Demographics
NPI:1629642921
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:ADMINISTRATOR
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:626-497-6500
Mailing Address - Street 1:3850 SMITH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2614
Mailing Address - Country:US
Mailing Address - Phone:213-261-4978
Mailing Address - Fax:818-471-4287
Practice Address - Street 1:3850 SMITH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2614
Practice Address - Country:US
Practice Address - Phone:213-261-4978
Practice Address - Fax:818-471-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE