Healthcare Provider Details

I. General information

NPI: 1558120436
Provider Name (Legal Business Name): MOBILE MEDICAL TEAM INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 ELECTRIC AVE STE C
PORT HURON MI
48060-6588
US

IV. Provider business mailing address

111 2ND ST
SAUSALITO CA
94965-2526
US

V. Phone/Fax

Practice location:
  • Phone: 415-332-2600
  • Fax:
Mailing address:
  • Phone: 415-332-2600
  • Fax: 415-332-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MOYNIHAN
Title or Position: INTERIM MEDICAL DIRECTOR
Credential: MD
Phone: 916-296-0495