Active NPI
Russell G Mobley, PA-C
- Physician Assistant
- Ontario, CA
National Provider Identifier
1073881793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA21877
- Practice address
- 730 North Turner Ave
Apt 2
Ontario, CA 91764 - Phone
- (909) 728-1587
- NPI assigned
- Dec 8, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA21877 | CA | Primary |
Addresses
Primary practice location
730 North Turner Ave
Apt 2
Ontario, CA 91764
Mailing address
730 N Turner Ave
Apt 2
Ontario, CA 91764-5524
Phone (190) 972-1587
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA21877 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1073881793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 N TURNER AVE",
"address_2": "APT 2",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917645524",
"telephone_number": "190-972-1587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 NORTH TURNER AVE",
"address_2": "APT 2",
"city": "ONTARIO",
"state": "CA",
"postal_code": "91764",
"telephone_number": "909-728-1587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOBLEY",
"first_name": "RUSSELL",
"middle_name": "G",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-08",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA21877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.