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General NPI Number Information
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NPI Number | 1912727835
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Entity Type | Organization
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Legal Business Name | INFINITY MOBILE MEDICAL GROUP
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 17337 VENTURA BLVD STE 220
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City | ENCINO
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State | CA
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Zip | 91316-4039
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Country | US
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Telephone | 818-518-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 17337 VENTURA BLVD STE 220
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City | ENCINO
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State | CA
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Zip | 91316-4039
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Country | US
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Telephone | 818-518-0146
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. CONCEPCION CABELLON-SAMUELS
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Credential |
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Telephone | 818-518-0146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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