Healthcare Provider Details

I. General information

NPI: 1174950067
Provider Name (Legal Business Name): MOBILE MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12650 SHERMAN WAY STE 3
NORTH HOLLYWOOD CA
91605-5248
US

IV. Provider business mailing address

12650 SHERMAN WAY STE 3
NORTH HOLLYWOOD CA
91605-5248
US

V. Phone/Fax

Practice location:
  • Phone: 760-400-8148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA104536
License Number StateCA

VIII. Authorized Official

Name: DR. ZIZHUANG LI
Title or Position: PROVIDER/OWNER
Credential: M.D. AND SURGEON
Phone: 760-400-8148