Healthcare Provider Details

I. General information

NPI: 1689426512
Provider Name (Legal Business Name): MOBILE CLINIC TEAM CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 COTTAGE WAY STE G2-23492
SACRAMENTO CA
95825-1474
US

IV. Provider business mailing address

3400 COTTAGE WAY STE G2-23492
SACRAMENTO CA
95825-1474
US

V. Phone/Fax

Practice location:
  • Phone: 818-796-5355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: PATRICK ROBERTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-796-5355