Healthcare Provider Details

I. General information

NPI: 1669185237
Provider Name (Legal Business Name): AT YOUR SERVICE MOBILE UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 SANTA MONICA BLVD STE 106-743
LOS ANGELES CA
90025-2276
US

IV. Provider business mailing address

11870 SANTA MONICA BLVD STE 106-743
LOS ANGELES CA
90025-2276
US

V. Phone/Fax

Practice location:
  • Phone: 425-522-2333
  • Fax: 323-395-0671
Mailing address:
  • Phone: 425-522-2333
  • Fax: 323-395-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: PHABILLIA BORJA
Title or Position: OWNER/CEO
Credential: MD
Phone: 425-522-2333