Provider Demographics
NPI:1629729157
Name:MOBILE COVID T LLC
Entity Type:Organization
Organization Name:MOBILE COVID T LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL NURSE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-766-5921
Mailing Address - Street 1:1435 W 105TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4572
Mailing Address - Country:US
Mailing Address - Phone:909-766-5921
Mailing Address - Fax:
Practice Address - Street 1:1435 W 105TH ST APT 12
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4572
Practice Address - Country:US
Practice Address - Phone:909-766-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No333300000XSuppliersEmergency Response System Companies