Healthcare Provider Details

I. General information

NPI: 1881863629
Provider Name (Legal Business Name): MRI DIAGNOSTOCS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 SOTO ST #102
HUNTINGTON PARK CA
90255-2629
US

IV. Provider business mailing address

5608 SOTO ST #102
HUNTINGTON PARK CA
90255-2629
US

V. Phone/Fax

Practice location:
  • Phone: 323-583-4717
  • Fax:
Mailing address:
  • Phone: 323-583-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA85846
License Number StateCA

VIII. Authorized Official

Name: GEORGE N ELIAS
Title or Position: OWNER
Credential:
Phone: 323-583-4717