Healthcare Provider Details

I. General information

NPI: 1578312096
Provider Name (Legal Business Name): MOBILE MEDICAL PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 CUSHMAN RD
ROCKVILLE MD
20852-3608
US

IV. Provider business mailing address

11424 CUSHMAN RD
ROCKVILLE MD
20852-3608
US

V. Phone/Fax

Practice location:
  • Phone: 973-715-1563
  • Fax:
Mailing address:
  • Phone: 973-715-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MAURO SARMIENTO
Title or Position: CEO
Credential: MD, PHD, MBA
Phone: 973-715-1563