MEDICARE: BLUEBEAM OP, LLC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1811788854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBEAM OP, LLC

Provider Business Mailing Address
First Line	:	3902 EL CAJON BLVD STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1016
Country	:	US
Telephone Number	:	888-992-3240
Fax Number	:	888-992-3340

Provider Business Practice Location Address
First Line	:	3902 EL CAJON BLVD STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1016
Country	:	US
Telephone Number	:	888-992-3240
Fax Number	:	888-992-3340

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MICHAEL ADENIRANYE
Credential	:
Telephone Number	:	888-992-3240

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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