Healthcare Provider Details

I. General information

NPI: 1437641727
Provider Name (Legal Business Name): MEDICAL IMAGING CENTER OF SOUTHERN CALIFORNIA-BEVERLY HILLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 BEVERLY BLVD
LOS ANGELES CA
90048
US

IV. Provider business mailing address

2811 WILSHIRE BLVD GROUND FLOOR
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-9788
  • Fax: 310-584-9999
Mailing address:
  • Phone: 310-829-9788
  • Fax: 310-584-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY JABOUR
Title or Position: OWNER
Credential: M.D.
Phone: 310-829-9788