Provider Demographics
NPI:1982004396
Name:MED MOBILE LIFE
Entity Type:Organization
Organization Name:MED MOBILE LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-237-6436
Mailing Address - Street 1:2806 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4705
Mailing Address - Country:US
Mailing Address - Phone:210-278-2324
Mailing Address - Fax:210-305-4202
Practice Address - Street 1:2806 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-4705
Practice Address - Country:US
Practice Address - Phone:210-278-2324
Practice Address - Fax:210-305-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies