Healthcare Provider Details

I. General information

NPI: 1659532026
Provider Name (Legal Business Name): PORTABLE QUALITY ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 SEQUOIA AVE
LINDSAY CA
93247-1447
US

IV. Provider business mailing address

1008 MEADBROOK ST
LAS VEGAS NV
89110-1436
US

V. Phone/Fax

Practice location:
  • Phone: 559-791-5271
  • Fax:
Mailing address:
  • Phone: 559-791-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number6723
License Number StateCA

VIII. Authorized Official

Name: MRS. MANUEL F ARELLANO
Title or Position: OWNER
Credential:
Phone: 702-499-3580