Healthcare Provider Details

I. General information

NPI: 1346272838
Provider Name (Legal Business Name): NATIONAL MRI, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

3605 LONG BEACH BLVD #306
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-2074
  • Fax: 562-988-2037
Mailing address:
  • Phone: 562-988-2074
  • Fax: 562-988-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License NumberG170420
License Number StateCA

VIII. Authorized Official

Name: JEFF M VANDEVER
Title or Position: MEDICAL BILLER/ COLLECTOR
Credential:
Phone: 562-988-2074