Healthcare Provider Details

I. General information

NPI: 1255313698
Provider Name (Legal Business Name): SUPERIOR MOBILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 06/13/2024
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 220TH ST SUITE 208
CARSON CA
90810-1649
US

IV. Provider business mailing address

1950 E 220TH ST SUITE 208
CARSON CA
90810-1649
US

V. Phone/Fax

Practice location:
  • Phone: 310-218-2040
  • Fax: 866-837-2297
Mailing address:
  • Phone: 310-218-2040
  • Fax: 310-218-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number77465
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierZZZ78492Z
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: DOUGLAS ZAER
Title or Position: CEO
Credential:
Phone: 310-755-6480