Healthcare Provider Details

I. General information

NPI: 1992844088
Provider Name (Legal Business Name): MEDICAL CENTER MAGNETIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 TELEGRAPH AVE
OAKLAND CA
94609-3218
US

IV. Provider business mailing address

3000 TELEGRAPH AVE
OAKLAND CA
94609-3218
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8777
  • Fax: 510-893-0332
Mailing address:
  • Phone: 510-869-8777
  • Fax: 510-893-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON ADAMS
Title or Position: CFO
Credential:
Phone: 510-869-6825