Healthcare Provider Details

I. General information

NPI: 1740854934
Provider Name (Legal Business Name): GOTMOBILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 E ARABIAN LN
SPOKANE WA
99208-6735
US

IV. Provider business mailing address

1218 E ARABIAN LN
SPOKANE WA
99208-6735
US

V. Phone/Fax

Practice location:
  • Phone: 949-466-9939
  • Fax: 949-281-7707
Mailing address:
  • Phone: 949-466-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARTIN CANALES
Title or Position: MEMBER
Credential:
Phone: 949-466-9939