Healthcare Provider Details

I. General information

NPI: 1750670584
Provider Name (Legal Business Name): MAF IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 BUSINESS CENTER DR
SAN BERNARDINO CA
92408-3457
US

IV. Provider business mailing address

PO BOX 49911
LOS ANGELES CA
90049-0911
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5552
  • Fax: 909-890-5588
Mailing address:
  • Phone: 310-481-0858
  • Fax: 310-474-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOOSSA HEIKALI
Title or Position: CEO/OWNER
Credential: M.D
Phone: 310-481-0858