Healthcare Provider Details

I. General information

NPI: 1154409100
Provider Name (Legal Business Name): MAX MRI IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17530 VENTURA BLVD SUITE 105
ENCINO CA
91316
US

IV. Provider business mailing address

17530 VENTURA BLVD SUITE 105
ENCINO CA
91316
US

V. Phone/Fax

Practice location:
  • Phone: 818-382-2220
  • Fax: 818-382-2270
Mailing address:
  • Phone: 818-382-2220
  • Fax: 818-382-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA33257
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberG29061
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberG18577
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ANNA MARIE RODRIGUEZ
Title or Position: MANAGER
Credential:
Phone: 818-382-2220