# MOBILE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MOBILE MEDICAL LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912461856
- **Authorized official:** TABITHA ROSE TAYLOR (OWNER)
- **Authorized official phone:** (602) 881-5430

## Contact information

- **Practice address:** 4120 N 108TH AVE STE 116, PHOENIX, AZ 85037-5773
- **Practice address phone:** (602) 881-5430
- **Practice address fax:** (623) 399-9958
- **Mailing address:** 8109 W DREYFUS DR, PEORIA, AZ 85381-4954
- **Mailing address phone:** (602) 881-5430
- **Mailing address fax:** (623) 399-9958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 01/24/2019
- **Last updated:** 06/11/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 33819 | MED DIRECTORS AZ LIC NUMBER | AZ |