Healthcare Provider Details

I. General information

NPI: 1801237730
Provider Name (Legal Business Name): PALM MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N PALM CANYON DR STE 113A
PALM SPRINGS CA
92262-5697
US

IV. Provider business mailing address

333 N PALM CANYON DR STE 113A
PALM SPRINGS CA
92262-5697
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-7390
  • Fax: 760-969-7387
Mailing address:
  • Phone: 760-969-7390
  • Fax: 760-969-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number32118
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number1515
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number32118
License Number StateCA

VIII. Authorized Official

Name: MYRA CHASON
Title or Position: CFO
Credential:
Phone: 310-871-1501