Healthcare Provider Details

I. General information

NPI: 1740964097
Provider Name (Legal Business Name): RED SEA MEDICAL IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14739 RICHVALE DR
LA MIRADA CA
90638-1036
US

IV. Provider business mailing address

PO BOX 88628
LOS ANGELES CA
90009-8628
US

V. Phone/Fax

Practice location:
  • Phone: 562-277-5617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAHASAYE ARAYA
Title or Position: OWNER
Credential:
Phone: 562-277-5617