Healthcare Provider Details

I. General information

NPI: 1700355013
Provider Name (Legal Business Name): SOCAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 SANTA ROSALIA DR
LOS ANGELES CA
90008-3611
US

IV. Provider business mailing address

3760 SANTA ROSALIA DR
LOS ANGELES CA
90008-3611
US

V. Phone/Fax

Practice location:
  • Phone: 888-814-0206
  • Fax:
Mailing address:
  • Phone: 888-814-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: REYMOND GAMZELETOVA
Title or Position: PRESIDENT
Credential:
Phone: 818-402-2831