Healthcare Provider Details

I. General information

NPI: 1891332052
Provider Name (Legal Business Name): KUMARS PORTABLE XRAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 GLENCREST DR
MODESTO CA
95355-8431
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-575-4598
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE DOLE
Title or Position: MANAGER
Credential:
Phone: 209-575-4575