Provider Demographics
NPI:1023146495
Name:FOBI MEDICAL GROUP
Entity type:Organization
Organization Name:FOBI MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-402-9779
Mailing Address - Street 1:21520 PIONEER BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2603
Mailing Address - Country:US
Mailing Address - Phone:562-402-9779
Mailing Address - Fax:562-402-9449
Practice Address - Street 1:432 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4424
Practice Address - Country:US
Practice Address - Phone:562-491-7935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30361174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty