Provider Demographics
NPI:1053394304
Name:SOUTHERN CALIFORNIA MOBILITY INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DE COU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-596-9400
Mailing Address - Street 1:PO BOX 4169
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-4169
Mailing Address - Country:US
Mailing Address - Phone:714-596-9400
Mailing Address - Fax:714-596-9500
Practice Address - Street 1:18368 ENTERPRISE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1201
Practice Address - Country:US
Practice Address - Phone:714-596-9400
Practice Address - Fax:714-596-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
1091510001Medicare NSC