Healthcare Provider Details

I. General information

NPI: 1134839848
Provider Name (Legal Business Name): COVALENT RADIOLOGY INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 WARING CT STE N
OCEANSIDE CA
92056-4510
US

IV. Provider business mailing address

11199 TESOTA LOOP ST
CORONA CA
92883-3059
US

V. Phone/Fax

Practice location:
  • Phone: 714-801-8878
  • Fax:
Mailing address:
  • Phone: 714-801-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL EMEEL MOUSA
Title or Position: DIRECTOR
Credential: MD
Phone: 714-801-8878