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General NPI Number Information
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NPI Number | 1801307822
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Entity Type | Organization
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Legal Business Name | MOBILE PICC NURSE LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 10981 SAN DIEGO MISSION RD STE 112
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City | SAN DIEGO
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State | CA
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Zip | 92108-2448
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Country | US
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Telephone | 619-693-7399
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Fax | 877-887-9814
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Provider Business Mailing Address
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Address Line | 10981 SAN DIEGO MISSION RD STE 112
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City | SAN DIEGO
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State | CA
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Zip | 92108-2448
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Country | US
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Telephone | 619-693-7399
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Fax | 877-887-9814
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KEVIN ROGERS
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Credential | MPH
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Telephone | 619-962-6985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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