Healthcare Provider Details

I. General information

NPI: 1598412827
Provider Name (Legal Business Name): ADVANCED MOBILE LAB AND X-RAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S MAGNOLIA AVE STE 201
EL CAJON CA
92020-5224
US

IV. Provider business mailing address

330 S MAGNOLIA AVE STE 201
EL CAJON CA
92020-5224
US

V. Phone/Fax

Practice location:
  • Phone: 619-788-0532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW RAZUKI
Title or Position: MEMBER
Credential:
Phone: 619-788-0532