Healthcare Provider Details

I. General information

NPI: 1073036315
Provider Name (Legal Business Name): UNITED MOBILE RAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CARTAGENA ST
LONG BEACH CA
90807
US

IV. Provider business mailing address

1720 E CARTAGENA ST
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-254-2640
  • Fax:
Mailing address:
  • Phone: 265-254-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL MORA
Title or Position: TECHNICIAN
Credential: R.T (R) ARRT
Phone: 562-254-2640