Provider Demographics
NPI:1922457696
Name:QUALITAS MOBILE MEDICAL, PC
Entity Type:Organization
Organization Name:QUALITAS MOBILE MEDICAL, PC
Other - Org Name:QUALITAS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:858-829-1921
Mailing Address - Street 1:7660 FAY AVE
Mailing Address - Street 2:#329
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0021
Mailing Address - Country:US
Mailing Address - Phone:858-829-1921
Mailing Address - Fax:619-269-4362
Practice Address - Street 1:8787 COMPLEX DR
Practice Address - Street 2:130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1419
Practice Address - Country:US
Practice Address - Phone:619-882-3100
Practice Address - Fax:858-278-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care MedicineGroup - Multi-Specialty