Healthcare Provider Details

I. General information

NPI: 1326183054
Provider Name (Legal Business Name): MOBILE MEDICAL OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 3RD ST
EUREKA CA
95501-0711
US

IV. Provider business mailing address

PO BOX 2020
EUREKA CA
95502-2020
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4666
  • Fax: 707-443-6123
Mailing address:
  • Phone: 707-443-4666
  • Fax: 707-443-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number110000327
License Number StateCA

VIII. Authorized Official

Name: MS. TERRI LYNN CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-443-4666