Healthcare Provider Details

I. General information

NPI: 1285192799
Provider Name (Legal Business Name): RIVANDI IMAGING AND HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 11/05/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 LONG BEACH BLVD
SOUTH GATE CA
90280-2014
US

IV. Provider business mailing address

10910 LONG BEACH BLVD STE 103-108
LYNWOOD CA
90262-2689
US

V. Phone/Fax

Practice location:
  • Phone: 323-484-0086
  • Fax: 323-484-0411
Mailing address:
  • Phone: 323-484-0086
  • Fax: 323-484-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI HOSSEINI RIVANDI
Title or Position: PRESIDENT
Credential: MD
Phone: 678-595-6753