MEDICARE: MONTEBELLO OPEN MRI 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1952417701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEBELLO OPEN MRI LLC

Provider Business Mailing Address
First Line	:	PO BOX 10609
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91510-0609
Country	:	US
Telephone Number	:	818-526-0200
Fax Number	:	818-526-0258

Provider Business Practice Location Address
First Line	:	1918 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640
Country	:	US
Telephone Number	:	323-838-6800
Fax Number	:	323-838-6807

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	ARTHUR EDWARD QUILLO
Credential	:
Telephone Number	:	949-250-4500

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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