Organization
MOBILE MED MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HIPOLITO GALLARDO MARIANO JR. MD (PRESIDENT)
(559) 330-7904
Entity
Organization
Contact information
Practice address
5454 E NEES AVE, CLOVIS, CA 93611-9503
(559) 330-7904
Mailing address
5454 E NEES AVE, CLOVIS, CA 93611-9503
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144451659
—
CA
Enumeration date
04/14/2020
Last updated
04/14/2020
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