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General NPI Number Information
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NPI Number | 1326447442
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Entity Type | Organization
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Legal Business Name | MOBILEVAX LLC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 1200 FRESNO AVE
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City | MCALLEN
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State | TX
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Zip | 78501-4932
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Country | US
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Telephone | 956-331-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 FRESNO AVE
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City | MCALLEN
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State | TX
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Zip | 78501-4932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUAN SANCHEZ
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Credential |
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Telephone | 956-331-5774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | H3497
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License Number State | TX
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