Healthcare Provider Details

I. General information

NPI: 1013490846
Provider Name (Legal Business Name): ALERT MOBILE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31945 COAST HWY
LAGUNA BEACH CA
92651-6867
US

IV. Provider business mailing address

31945 COAST HWY
LAGUNA BEACH CA
92651-6867
US

V. Phone/Fax

Practice location:
  • Phone: 702-308-2453
  • Fax:
Mailing address:
  • Phone: 702-308-2453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number72258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON LIU
Title or Position: MEMBER
Credential: MD
Phone: 702-308-2453