Provider Demographics
NPI:1770308041
Name:MOBIALYSIS LLC
Entity type:Organization
Organization Name:MOBIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TEODULO
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:BONZON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-846-4469
Mailing Address - Street 1:3013 ANNITA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1302
Mailing Address - Country:US
Mailing Address - Phone:818-846-4469
Mailing Address - Fax:
Practice Address - Street 1:3013 ANNITA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1302
Practice Address - Country:US
Practice Address - Phone:818-846-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment