Healthcare Provider Details

I. General information

NPI: 1235362997
Provider Name (Legal Business Name): CALIFORNIA MRI & DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WASHINGTON BLVD STE D
MARINA DEL REY CA
90292-5178
US

IV. Provider business mailing address

4712 ADMIRALTY WAY # 361
MARINA DEL REY CA
90292-6905
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-1800
  • Fax:
Mailing address:
  • Phone: 818-701-1800
  • Fax: 818-885-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number261QM1200X
License Number StateCA

VIII. Authorized Official

Name: JEFF STEVENS
Title or Position: PRESIDENT
Credential:
Phone: 818-701-1800