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General NPI Number Information
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NPI Number | 1568647725
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Entity Type | Organization
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Legal Business Name | MOBILE CARE SERVICES, INC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1280 E COOLEY DR SUITE 29
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City | COLTON
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State | CA
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Zip | 92324-3932
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Country | US
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Telephone | 909-783-6597
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Fax | 909-514-1812
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Provider Business Mailing Address
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Address Line | 1280 E COOLEY DR SUITE 29
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City | COLTON
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State | CA
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Zip | 92324-3932
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Country | US
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Telephone | 909-783-6597
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Fax | 909-514-1812
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Authorized Official
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Title or Position | PRIMARY CARE PHYSICIAN
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Name | DR. WILSON DUGADUGA LAO
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Credential | M.D.
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Telephone | 909-663-7002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A56414
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License Number State | CA
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