Healthcare Provider Details

I. General information

NPI: 1386754232
Provider Name (Legal Business Name): MOBILE RADIOLOGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11177 TAMPA AVE. SUITE B
NORTHRIDGE CA
91326-2254
US

IV. Provider business mailing address

P.O. BOX 8000
NORTHRIDGE CA
91327-8000
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-0474
  • Fax: 818-474-7530
Mailing address:
  • Phone: 818-366-0474
  • Fax: 818-474-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJIV K. JAIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-366-0474