Healthcare Provider Details

I. General information

NPI: 1255899209
Provider Name (Legal Business Name): NONINVASIVE MEDICAL IMAGING INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 TAMPA AVE STE 101
RESEDA CA
91335-1713
US

IV. Provider business mailing address

PO BOX 261278
ENCINO CA
91426-1278
US

V. Phone/Fax

Practice location:
  • Phone: 818-718-1600
  • Fax: 818-343-1612
Mailing address:
  • Phone: 818-718-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROL A FORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-341-1883