Healthcare Provider Details

I. General information

NPI: 1326356213
Provider Name (Legal Business Name): BIODATA RADIOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 ARROW HWY STE F4
MONTCLAIR CA
91763-1218
US

IV. Provider business mailing address

4650 ARROW HWY STE F4
MONTCLAIR CA
91763-1218
US

V. Phone/Fax

Practice location:
  • Phone: 909-333-4200
  • Fax: 949-281-7707
Mailing address:
  • Phone: 909-333-4200
  • Fax: 949-281-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARTIN CANALES
Title or Position: PARTNER
Credential:
Phone: 949-466-9939