Healthcare Provider Details

I. General information

NPI: 1700048824
Provider Name (Legal Business Name): MOBILE MONITORING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17602 17TH ST SUITE#102 PMB#224
TUSTIN CA
92780-1961
US

IV. Provider business mailing address

17602 17TH ST SUITE#102 PMB#224
TUSTIN CA
92780-1961
US

V. Phone/Fax

Practice location:
  • Phone: 949-751-9790
  • Fax: 714-838-9195
Mailing address:
  • Phone: 949-751-9790
  • Fax: 714-838-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2975
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2975
License Number StateCA

VIII. Authorized Official

Name: MS. ANDREA IRENE ROUGHT
Title or Position: OWNER
Credential: R. EEG. T
Phone: 949-751-9790