Healthcare Provider Details

I. General information

NPI: 1518202282
Provider Name (Legal Business Name): DOREEN MOBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 OLIVIA ST APT 4B
KEY WEST FL
33040-7359
US

IV. Provider business mailing address

329 OLIVIA ST APT 4B
KEY WEST FL
33040
US

V. Phone/Fax

Practice location:
  • Phone: 305-517-6154
  • Fax:
Mailing address:
  • Phone: 305-517-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: