NPIMap

Organization Active NPI

Mobialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Glendale, CA
National Provider Identifier
1770308041
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MOBIALYSIS LLC
Practice address
3013 Annita Dr
Glendale, CA 91206-1302
Phone
(818) 846-4469
NPI assigned
Nov 20, 2024
Last updated
Nov 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teodulo Cruz Bonzon, LCSWNPI 1497039192
Title
Managing Member
Phone
(818) 846-4469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

3013 Annita Dr
Glendale, CA 91206-1302

Mailing address

3013 Annita Dr
Glendale, CA 91206-1302
Phone (818) 846-4469

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1770308041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3013 ANNITA DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061302",
            "telephone_number": "818-846-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 ANNITA DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061302",
            "telephone_number": "818-846-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "BONZON",
        "authorized_official_first_name": "TEODULO",
        "authorized_official_middle_name": "CRUZ",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "818-846-4469",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.