1033163548 NPI number — MAGNETIC IMAGING MEDICAL GROUP INC

Table of content: (NPI 1033163548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033163548 NPI number — MAGNETIC IMAGING MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAGNETIC IMAGING MEDICAL GROUP 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:
Provider Other Organization Name Type Code:
6
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:
1033163548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT. WS200
Provider Second Line Business Mailing Address:
PO BOX 509015
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92150-9015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-674-7933
Provider Business Mailing Address Fax Number:
952-513-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8515 FLORENCE AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90240-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-904-1340
Provider Business Practice Location Address Fax Number:
562-869-8606
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-904-1340

Provider Taxonomy Codes

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

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

  • Identifier: GR0041331 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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