Healthcare Provider Details

I. General information

NPI: 1659561926
Provider Name (Legal Business Name): MOBILE EXPRESS ULTRASOUND IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N ROSSMORE AVE 202
LOS ANGELES CA
90004-2453
US

IV. Provider business mailing address

531 N ROSSMORE AVE 202
LOS ANGELES CA
90004-2453
US

V. Phone/Fax

Practice location:
  • Phone: 213-448-6661
  • Fax: 323-466-7255
Mailing address:
  • Phone: 213-448-6661
  • Fax: 323-466-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number81173
License Number State

VIII. Authorized Official

Name: MR. SERGEY PEKUR
Title or Position: PRESIDENT
Credential: RVT, RDMS
Phone: 213-448-6661