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General NPI Number Information
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NPI Number | 1184294357
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL HEALTH
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 44330 MERCURE CIR STE 240E
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City | DULLES
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State | VA
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Zip | 20166-2024
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Country | US
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Telephone | 703-727-0523
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Fax |
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Provider Business Mailing Address
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Address Line | 44330 MERCURE CIR STE 240E
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City | DULLES
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State | VA
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Zip | 20166-2024
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Country | US
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Telephone | 703-727-0523
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DOUG EUSTAQUIO
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Credential |
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Telephone | 703-935-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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