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General NPI Number Information
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NPI Number | 1891708020
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL ADVANTAGE INC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 PURLIECE PLACE SUITE 131
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-740-7554
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Fax | 407-740-7751
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Provider Business Mailing Address
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Address Line | 1 PURLIECE PLACE SUITE 131
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-740-7554
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Fax | 407-740-7751
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Authorized Official
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Title or Position | PRES CEO
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Name | MRS. MARLENE T RODRIGUEZ
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Credential |
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Telephone | 407-740-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HCC6675
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License Number State | FL
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