1336383942 NPI number — ADVANCED MEDICAL XRAY INC

Table of content: (NPI 1336383942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336383942 NPI number — ADVANCED MEDICAL XRAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MEDICAL XRAY 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:
MOBILE DIGITAL XRAY
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:
1336383942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA VERNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91750-7938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-303-8674
Provider Business Mailing Address Fax Number:
626-256-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 ARROW HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91750-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-303-8674
Provider Business Practice Location Address Fax Number:
909-392-3824
Provider Enumeration Date:
04/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
FAUSTO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-303-8674

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , 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)