Provider Demographics
NPI:1306462742
Name:TOTAL CARE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:TOTAL CARE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-408-8714
Mailing Address - Street 1:3358 HILLSIDE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2829
Mailing Address - Country:US
Mailing Address - Phone:310-408-8714
Mailing Address - Fax:
Practice Address - Street 1:6040 S DURANGO DR STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1792
Practice Address - Country:US
Practice Address - Phone:310-408-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty