Healthcare Provider Details

I. General information

NPI: 1649548298
Provider Name (Legal Business Name): MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2011
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 LUNDY AVE SUITE 218
SAN JOSE CA
95131-1856
US

IV. Provider business mailing address

1879 LUNDY AVE SUITE 218
SAN JOSE CA
95131
US

V. Phone/Fax

Practice location:
  • Phone: 408-373-6176
  • Fax:
Mailing address:
  • Phone: 408-373-6176
  • Fax: 408-684-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. LLOYD MICHAEL JONES
Title or Position: CO-OWNER
Credential:
Phone: 408-373-6176