Healthcare Provider Details

I. General information

NPI: 1801405295
Provider Name (Legal Business Name): MEDICINE MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 STORKE RD STE 101
GOLETA CA
93117-2992
US

IV. Provider business mailing address

320 STORKE RD STE 101
GOLETA CA
93117-2992
US

V. Phone/Fax

Practice location:
  • Phone: 805-204-4882
  • Fax:
Mailing address:
  • Phone: 805-204-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: CONOR OBRIEN
Title or Position: CEO
Credential:
Phone: 209-712-8011