Organization · NPI-2

Active Mobile Medical Group, INC.

Family Medicine · Los Angeles, CA

NPI number1184370199
StatusActive
Last updated in NPPESMar 18, 2022

Details

NPI
1184370199
Entity type
Organization (NPI-2)
Legal business name
Active Mobile Medical Group, INC.
Organization subpart
No
Enumeration date
Feb 28, 2022
Certification date
Mar 18, 2022
Last updated
Mar 18, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes
261Q00000X Clinic/Center––

Practice location

3450 Wilshire Blvd Ste 1200
Los Angeles, CA 90010-2214

Phone 213-465-2643 · Fax 213-232-4944

Mailing address

3325 Wilshire Blvd Ste 208
Los Angeles, CA 90010-1733

Phone 213-465-2643 · Fax 213-232-4944

Authorized official

Joanna Balasico
Vice President
2134652643

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