Healthcare Provider Details

I. General information

NPI: 1770851776
Provider Name (Legal Business Name): ADVANCED MFM IMAGING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E. CHEVY CHASE DRIVE SUITE 300
GLENDALE CA
91206-4092
US

IV. Provider business mailing address

1577 E. CHEVY CHASE DRIVE SUITE 300
GLENDALE CA
91206-4092
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-8300
  • Fax: 818-240-8303
Mailing address:
  • Phone: 818-240-8300
  • Fax: 818-240-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRYSTYNE DANYELL
Title or Position: MSN, FNP, PRESIDENT
Credential:
Phone: 818-240-8300