Healthcare Provider Details

I. General information

NPI: 1780957860
Provider Name (Legal Business Name): MED IMAGING CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 MOTOR AVE
LOS ANGELES CA
90034-3712
US

IV. Provider business mailing address

11693 SAN VICENTE BLVD STE 389
LOS ANGELES CA
90049-5105
US

V. Phone/Fax

Practice location:
  • Phone: 734-788-9646
  • Fax: 310-424-3404
Mailing address:
  • Phone: 734-788-9646
  • Fax: 310-424-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA113116
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113116
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMAD REZVANI
Title or Position: CEO
Credential: MD
Phone: 734-788-9646