Healthcare Provider Details

I. General information

NPI: 1134144991
Provider Name (Legal Business Name): OPTISON MOBILE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 ARGONNE AVE
LONG BEACH CA
90803-3232
US

IV. Provider business mailing address

174 ARGONNE AVE
LONG BEACH CA
90803-3232
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-7866
  • Fax: 877-428-1296
Mailing address:
  • Phone: 562-439-7866
  • Fax: 877-428-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number11677
License Number StateCA

VIII. Authorized Official

Name: MR. MARK CLEMENT ENDRES
Title or Position: BUSINESS MANAGER
Credential:
Phone: 800-950-1161