Provider Demographics
NPI:1063696722
Name:DEL SOL MOBILE HEALTH LLC
Entity type:Organization
Organization Name:DEL SOL MOBILE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAXIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-726-0091
Mailing Address - Street 1:11274 S FORTUNA RD
Mailing Address - Street 2:SUITE I-3
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7847
Mailing Address - Country:US
Mailing Address - Phone:928-726-0091
Mailing Address - Fax:928-726-0092
Practice Address - Street 1:11274 S FORTUNA RD
Practice Address - Street 2:SUITE I-3
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7847
Practice Address - Country:US
Practice Address - Phone:928-726-0091
Practice Address - Fax:928-726-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
AZ1888261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77119Medicare PIN