Healthcare Provider Details

I. General information

NPI: 1124775093
Provider Name (Legal Business Name): PROFESSIONAL MOBILE IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72670 FRED WARING DR STE C-203
PALM DESERT CA
92260-5011
US

IV. Provider business mailing address

3112 DONA CLARA PL
STUDIO CITY CA
91604-4308
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-6111
  • Fax: 323-653-6220
Mailing address:
  • Phone: 323-327-6679
  • Fax: 760-678-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANASTASIA LABUTIN
Title or Position: CEO
Credential:
Phone: 323-327-6679