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General NPI Number Information
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NPI Number | 1205212586
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Entity Type | Organization
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Legal Business Name | MOBILIA DMD INC.
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 12405 RANCHO BERNARDO RD.
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-385-1838
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Fax | 858-385-1882
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Provider Business Mailing Address
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Address Line | 12405 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92128-2143
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Country | US
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Telephone | 858-385-1838
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Fax | 858-385-1882
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN AUTHUR MOBILIA
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Credential | DMD
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Telephone | 858-385-1838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 45924
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License Number State | CA
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