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General NPI Number Information
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NPI Number | 1023123940
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL & NURSING, INC.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 9091 N MILITARY TRL SUITE # 11
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5959
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Country | US
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Telephone | 844-889-0365
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Fax | 844-889-0366
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Provider Business Mailing Address
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Address Line | PO BOX 31176
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33420-1176
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Country | US
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Telephone | 844-889-0365
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Fax | 844-889-0366
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | MR. DINAKAR KOTIYAN
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Credential | ND, FNP
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Telephone | 844-889-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2686735
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License Number State | CA
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