MEDICARE: FASTSERV MOBILITY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5156830001	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	101793	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063409936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FASTSERV MOBILITY INC

Provider Business Mailing Address
First Line	:	10945 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2338
Country	:	US
Telephone Number	:	510-236-8101
Fax Number	:	510-236-8082

Provider Business Practice Location Address
First Line	:	10945 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2338
Country	:	US
Telephone Number	:	510-236-8101
Fax Number	:	510-236-8082

Authorized Official
Title or Position	:	CFO
Name	:	MS. VENESSA N DIXON
Credential	:
Telephone Number	:	510-236-8101

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	06/23/2008

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Directions to “FASTSERV MOBILITY INC ” Practice Location

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