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General NPI Number Information
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NPI Number | 1740691047
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE MOBILE MEDICINE, INC.
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 1650 E WALNUT ST
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City | PASADENA
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State | CA
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Zip | 91106-1619
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Country | US
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Telephone | 844-636-6245
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Fax | 844-636-6245
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Provider Business Mailing Address
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Address Line | 1650 E WALNUT ST
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City | PASADENA
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State | CA
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Zip | 91106-1619
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Country | US
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Telephone | 844-636-6245
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Fax | 844-636-6245
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MR. ANGEL BUSTAMANTE
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Credential | PA-C
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Telephone | 844-636-6245
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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 | 55037
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License Number State | CA
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