Organization
ACTIVE MOBILITY CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMMAD ISA SHALIKAR SR. DME (OWNER)
(760) 962-1050
Entity
Organization
Contact information
Practice address
14330 7TH ST, VICTORVILLE, CA 92395-4212
(760) 962-1050
(760) 962-1060
Mailing address
14330 7TH ST, VICTORVILLE, CA 92395-4212
(760) 962-1050
(760) 962-1060
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
138362
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
486756900
U.S. DEPT. OF LABOR-FECA
CA
05
—
DME 03297F
—
CA
Enumeration date
05/07/2007
Last updated
06/21/2018
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