Provider Demographics
NPI:1417787706
Name:MOBILITY TECHNOLOGY INTEGRATED LLC
Entity type:Organization
Organization Name:MOBILITY TECHNOLOGY INTEGRATED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-891-1881
Mailing Address - Street 1:14411 MARINA SAN PABLO PL S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4810
Mailing Address - Country:US
Mailing Address - Phone:949-891-1881
Mailing Address - Fax:
Practice Address - Street 1:950 10TH ST S # A9A10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3316
Practice Address - Country:US
Practice Address - Phone:949-891-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment