Healthcare Provider Details

I. General information

NPI: 1518107952
Provider Name (Legal Business Name): UNIVERSAL MRI & CT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WILSHIRE BLVD SUITE #100
LOS ANGELES CA
90036
US

IV. Provider business mailing address

5757 WILSHIRE BLVD SUITE #100
LOS ANGELES CA
90036
US

V. Phone/Fax

Practice location:
  • Phone: 323-648-0500
  • Fax: 323-648-0508
Mailing address:
  • Phone: 323-648-0500
  • Fax: 323-648-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA73716
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number0002336913-0001-8
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberA73716
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA73716
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA73716
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA73716
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number0002336913-0001-8
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number0002336913-0001-8
License Number StateCA

VIII. Authorized Official

Name: MS. PERLA I NUNEZ
Title or Position: SUPERVISOR
Credential:
Phone: 323-648-0500