Provider Demographics
NPI:1760225916
Name:CALIHEALTH MOBILE PHYSICIAN'S GROUP
Entity type:Organization
Organization Name:CALIHEALTH MOBILE PHYSICIAN'S GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-599-7066
Mailing Address - Street 1:16110 CRYSTAL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1918
Mailing Address - Country:US
Mailing Address - Phone:323-599-7066
Mailing Address - Fax:
Practice Address - Street 1:16110 CRYSTAL CREEK LN
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1918
Practice Address - Country:US
Practice Address - Phone:323-599-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty