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General NPI Number Information
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NPI Number | 1639219298
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Entity Type | Organization
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Legal Business Name | THE MOBILE MEDICAL OFFICE
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 1522 THIRD ST.
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City | EUREKA
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State | CA
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Zip | 95501-0711
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Country | US
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Telephone | 707-443-4666
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Fax | 707-443-6123
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Provider Business Mailing Address
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Address Line | P.O. BOX 2020
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City | EUREKA
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State | CA
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Zip | 95502-2020
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Country | US
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Telephone | 707-443-4666
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Fax | 707-443-6123
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Authorized Official
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Title or Position | CEO/CFO
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Name | MS. SALLY J. HEWITT
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Credential | M.H.A.
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Telephone | 707-443-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G86644
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License Number State | CA
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