Healthcare Provider Details

I. General information

NPI: 1700376506
Provider Name (Legal Business Name): SONO IMAGING MOBILE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

IV. Provider business mailing address

527 WESTMINSTER AVE
NEWPORT BEACH CA
92663-4260
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: HALEY CLEVELAND
Title or Position: DIAGNOSTIC MEDICAL SONOGRAPHER
Credential:
Phone: 714-955-3744