Healthcare Provider Details

I. General information

NPI: 1902008642
Provider Name (Legal Business Name): ADVANCED MEMORIAL IMAGING GROUP, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD #130
FULLERTON CA
92835-3419
US

IV. Provider business mailing address

17868 US HIGHWAY 18 #358
APPLE VALLEY CA
92307-1267
US

V. Phone/Fax

Practice location:
  • Phone: 714-278-9363
  • Fax: 714-278-9364
Mailing address:
  • Phone: 760-946-5177
  • Fax: 760-946-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAGDISH M. PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 714-278-9363