Healthcare Provider Details

I. General information

NPI: 1821167677
Provider Name (Legal Business Name): HALLMARK MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HALLMARK PKWY SUITE B
SAN BERNARDINO CA
92407-1877
US

IV. Provider business mailing address

PO BOX 90875
SAN BERNARDINO CA
92427-1875
US

V. Phone/Fax

Practice location:
  • Phone: 909-473-1944
  • Fax: 909-473-1130
Mailing address:
  • Phone: 909-887-8788
  • Fax: 909-887-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOM COLICCHIO
Title or Position: DIRECTOR
Credential:
Phone: 909-887-8788