Provider Demographics
NPI:1023123940
Name:MOBILE MEDICAL & NURSING, INC.
Entity type:Organization
Organization Name:MOBILE MEDICAL & NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DINAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND, FNP
Authorized Official - Phone:844-889-0365
Mailing Address - Street 1:PO BOX 31176
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-1176
Mailing Address - Country:US
Mailing Address - Phone:844-889-0365
Mailing Address - Fax:844-889-0366
Practice Address - Street 1:9091 N MILITARY TRL
Practice Address - Street 2:SUITE # 11
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5959
Practice Address - Country:US
Practice Address - Phone:844-889-0365
Practice Address - Fax:844-889-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2686735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03629ZMedicare PIN
CAW18199Medicare PIN