Healthcare Provider Details

I. General information

NPI: 1144778440
Provider Name (Legal Business Name): TOTAL CARE MOBILE MEDICAL UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 S VERMONT AVE
LOS ANGELES CA
90044-3112
US

IV. Provider business mailing address

10024 S VERMONT AVE
LOS ANGELES CA
90044-3112
US

V. Phone/Fax

Practice location:
  • Phone: 323-756-1412
  • Fax: 323-756-1413
Mailing address:
  • Phone: 323-756-1412
  • Fax: 323-756-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number550002631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number550002631
License Number StateCA

VIII. Authorized Official

Name: CARMEN BROWN
Title or Position: MANAGER
Credential: DO
Phone: 323-756-1412