Healthcare Provider Details

I. General information

NPI: 1679190664
Provider Name (Legal Business Name): PRIME MOBILE PHYSICIANS NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28212 KELLY JOHNSON PKWY STE 200
VALENCIA CA
91355-5090
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 209
NEWHALL CA
91321-5751
US

V. Phone/Fax

Practice location:
  • Phone: 213-228-3538
  • Fax: 818-356-4380
Mailing address:
  • Phone: 613-837-1366
  • Fax: 818-356-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: IZUCHUKWU OKPARA
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 213-228-3538