Healthcare Provider Details

I. General information

NPI: 1124521331
Provider Name (Legal Business Name): ADVANCED MFM IMAGING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E CHEVY CHASE DR STE 300
GLENDALE CA
91206-4092
US

IV. Provider business mailing address

1577 E CHEVY CHASE DR STE 300
GLENDALE CA
91206-4092
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-8300
  • Fax:
Mailing address:
  • Phone: 818-240-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA69154
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA32023
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA32023
License Number StateCA

VIII. Authorized Official

Name: KRYSTYNE DANYELL
Title or Position: PRESIDENT
Credential: RN
Phone: 818-939-4040