Healthcare Provider Details

I. General information

NPI: 1619044534
Provider Name (Legal Business Name): MAMMO Q PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22020 AVALON BLVD
CARSON CA
90745-3307
US

IV. Provider business mailing address

22020 S AVALON BLVD
CARSON CA
90745-2734
US

V. Phone/Fax

Practice location:
  • Phone: 310-518-2620
  • Fax: 310-835-5799
Mailing address:
  • Phone: 310-518-2620
  • Fax: 310-835-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA TARROZA VIDA
Title or Position: PRESIDENT
Credential:
Phone: 310-518-2620