Healthcare Provider Details

I. General information

NPI: 1144436601
Provider Name (Legal Business Name): RADIOLOGY SPECIALTY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E WARDLOW RD
LONG BEACH CA
90807-4736
US

IV. Provider business mailing address

2201 E WILLOW ST STE D206
SIGNAL HILL CA
90755-2148
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-7773
  • Fax: 562-437-1440
Mailing address:
  • Phone: 562-437-7773
  • Fax: 562-437-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG10742
License Number StateCA

VIII. Authorized Official

Name: MS. BARBARA JANICE LABEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 866-473-7773