Healthcare Provider Details

I. General information

NPI: 1356650105
Provider Name (Legal Business Name): DESERT MRI LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 E CALLE MERIDAN
TUSCON AZ
85710
US

IV. Provider business mailing address

7340 E CALLE MERIDAN
TUCSON AZ
85710
US

V. Phone/Fax

Practice location:
  • Phone: 520-820-9313
  • Fax: 520-495-5015
Mailing address:
  • Phone: 520-820-9313
  • Fax: 520-495-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. WILDA C. DAVIS
Title or Position: OWNER
Credential:
Phone: 520-820-9313