Healthcare Provider Details

I. General information

NPI: 1194671073
Provider Name (Legal Business Name): SKYLINE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 1ST AVE APT 24
COVINA CA
91723-2667
US

IV. Provider business mailing address

320 S 1ST AVE APT 24
COVINA CA
91723-2667
US

V. Phone/Fax

Practice location:
  • Phone: 910-459-9956
  • Fax:
Mailing address:
  • Phone: 910-459-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN URBINA
Title or Position: OWNER
Credential: RT(R)
Phone: 910-459-9956