Healthcare Provider Details

I. General information

NPI: 1952758849
Provider Name (Legal Business Name): INNOVATIVE MINIMALLY INVASIVE IMAGING & THERAPEUTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8283 GROVE AVE STE 207A
RANCHO CUCAMONGA CA
91730-3141
US

IV. Provider business mailing address

PO BOX 379
PASADENA CA
91102-0379
US

V. Phone/Fax

Practice location:
  • Phone: 401-575-0308
  • Fax: 562-548-7540
Mailing address:
  • Phone: 401-575-0308
  • Fax: 562-548-7540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA92815
License Number StateCA

VIII. Authorized Official

Name: DR. MALWINDER S SINGHA
Title or Position: PRESIDENT
Credential: MD
Phone: 401-575-0308