Provider Demographics
NPI:1063409936
Name:FASTSERV MOBILITY INC
Entity type:Organization
Organization Name:FASTSERV MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:VENESSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-236-8101
Mailing Address - Street 1:10945 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2338
Mailing Address - Country:US
Mailing Address - Phone:510-236-8101
Mailing Address - Fax:510-236-8082
Practice Address - Street 1:10945 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2338
Practice Address - Country:US
Practice Address - Phone:510-236-8101
Practice Address - Fax:510-236-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5156830001332B00000X
CA101793332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02213GMedicaid
CADME02213FMedicaid
5156830001Medicare NSC