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General NPI Number Information
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NPI Number | 1942447651
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL GROUP
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 5030 CAMINO DE LA SIESTA SUITE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-3116
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Country | US
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Telephone | 619-260-6300
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Fax | 619-260-6313
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Provider Business Mailing Address
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Address Line | 5030 CAMINO DE LA SIESTA SUITE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-3116
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Country | US
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Telephone | 619-260-6300
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Fax | 619-260-6313
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARY GRESHAM BAYNE
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Credential | M.D.
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Telephone | 619-260-6300
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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 | FAC41617
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License Number State | CA
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