Provider Demographics
NPI:1649015298
Name:MARYLAND MOBILE HEALTH LLC
Entity type:Organization
Organization Name:MARYLAND MOBILE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-389-3444
Mailing Address - Street 1:3909 S MARYLAND PKWY
Mailing Address - Street 2:STE 414
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-389-3444
Mailing Address - Fax:702-714-1720
Practice Address - Street 1:3909 S MARYLAND PKWY
Practice Address - Street 2:STE 414
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-389-3444
Practice Address - Fax:702-714-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center