Provider Demographics
NPI:1639490881
Name:SOUTHERN CALIFORNIA MOBILITY DYNAMICS INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MOBILITY DYNAMICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARICH
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:714-847-7300
Mailing Address - Street 1:16321 GOTHARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3645
Mailing Address - Country:US
Mailing Address - Phone:714-847-7300
Mailing Address - Fax:714-847-7338
Practice Address - Street 1:16321 GOTHARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3645
Practice Address - Country:US
Practice Address - Phone:714-847-7300
Practice Address - Fax:714-847-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
6484660001Medicare NSC