1578858585 NPI number — AM & BB IMAGING CENTER INC

Table of content: (NPI 1578858585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578858585 NPI number — AM & BB IMAGING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AM & BB IMAGING CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IMPERIAL RADIOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578858585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6010 HIDDEN VALLEY RD
Provider Second Line Business Mailing Address:
STE 125
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-4213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-730-3536
Provider Business Mailing Address Fax Number:
760-720-4833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2407 MARSHALL AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251-9504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-730-3536
Provider Business Practice Location Address Fax Number:
760-720-4833
Provider Enumeration Date:
06/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAGHSOUDY
Authorized Official First Name:
AFSANEH
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY, OWNER
Authorized Official Telephone Number:
760-730-3536

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A606220 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".