| Mobile Medical Providers, Inc. | |
|
19634 Ventura Blvd Ste 321 Tarzana CA 91356-2994 | |
| (310) 388-8788 | |
| (855) 667-6377 |
| Full Name | Mobile Medical Providers, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 19634 Ventura Blvd Ste 321, Tarzana, California |
| Authorized Official Name and Position | Boules Salib (PRESIDENT) |
| Authorized Official Contact | 3103888788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Medical Providers, Inc. 19634 Ventura Blvd Ste 321 Tarzana CA 91356-2994 Ph: (310) 388-8788 | Mobile Medical Providers, Inc. 19634 Ventura Blvd Ste 321 Tarzana CA 91356-2994 Ph: (310) 388-8788 |
| NPI Number | 1528462033 |
|---|---|
| Provider Enumeration Date | 10/13/2014 |
| Last Update Date | 12/04/2019 |
| Medicare PECOS PAC ID | 7810215787 |
|---|---|
| Medicare Enrollment ID | O20150406002267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528462033 | NPI | - | NPPES |
| CB229346 | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A125934 (California) | Primary |
| Provider Name | Boules Salib |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437302692 PECOS PAC ID: 3971643875 Enrollment ID: I20131118001675 |
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