Healthcare Provider Details

I. General information

NPI: 1912727835
Provider Name (Legal Business Name): INFINITY MOBILE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17337 VENTURA BLVD STE 220
ENCINO CA
91316-4039
US

IV. Provider business mailing address

17337 VENTURA BLVD STE 220
ENCINO CA
91316-4039
US

V. Phone/Fax

Practice location:
  • Phone: 818-518-0146
  • Fax:
Mailing address:
  • Phone: 818-518-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. CONCEPCION CABELLON-SAMUELS
Title or Position: CEO
Credential:
Phone: 818-518-0146