1578588323 NPI number — UNIVERSAL OPEN MRI AND DIAGNOSTIC CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578588323 NPI number — UNIVERSAL OPEN MRI AND DIAGNOSTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL OPEN MRI AND DIAGNOSTIC CENTER
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:
Provider Other Organization Name Type Code:
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:
1578588323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1403 LOMITA BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
HARBOR CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90710-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-325-9901
Provider Business Mailing Address Fax Number:
310-325-0202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SHERMAN AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-325-9901
Provider Business Practice Location Address Fax Number:
310-325-0202
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE DIRECTOR
Authorized Official Telephone Number:
310-325-9901

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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