| Mobile Med Md Inc | |
|
5454 E Nees Ave Clovis CA 93611-9503 | |
| (559) 330-7904 | |
| Not Available |
| Full Name | Mobile Med Md Inc |
|---|---|
| Speciality | General Practice |
| Location | 5454 E Nees Ave, Clovis, California |
| Authorized Official Name and Position | Hipolito Gallardo Mariano (PRESIDENT) |
| Authorized Official Contact | 5593307904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Med Md Inc 5454 E Nees Ave Clovis CA 93611-9503 Ph: () - | Mobile Med Md Inc 5454 E Nees Ave Clovis CA 93611-9503 Ph: (559) 330-7904 |
| NPI Number | 1861011389 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 04/14/2020 |
| Medicare PECOS PAC ID | 9234549916 |
|---|---|
| Medicare Enrollment ID | O20201109001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861011389 | NPI | - | NPPES |
| 1144451659 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Hipolito G Mariano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376685685 PECOS PAC ID: 2062503337 Enrollment ID: I20070801000612 |
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