MEDICARE: UNIVERSAL MRI & CT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A73716	CA
2	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	A73716	CA
3	2085U0001X	Diagnostic Ultrasound Physician	A73716	CA
4	2085B0100X	Body Imaging Physician	A73716	CA
5	2085R0204X	Vascular & Interventional Radiology Physician	A73716	CA
6	2085B0100X	Body Imaging Physician	0002336913-0001-8	CA
7	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	0002336913-0001-8	CA
8	247100000X	Radiologic Technologist	0002336913-0001-8	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A73716	OTHER	CA	CA LICENCE

General Provider Information

NPI Number	:	1518107952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MRI & CT INC

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD SUITE #100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD SUITE #100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	MS. PERLA I NUNEZ
Credential	:
Telephone Number	:	323-648-0500

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	07/02/2010

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