Healthcare Provider Details

I. General information

NPI: 1457547663
Provider Name (Legal Business Name): M.R.DIAGNOSTIC IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N SWALL DR APT 202
BEVERLY HILLS CA
90211-1926
US

IV. Provider business mailing address

116 N SWALL DR APT 202
BEVERLY HILLS CA
90211-1926
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-1303
  • Fax: 818-888-1544
Mailing address:
  • Phone: 310-659-1303
  • Fax: 818-888-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LILIYAN PEPPER
Title or Position: OWNER
Credential:
Phone: 310-659-1303