Healthcare Provider Details

I. General information

NPI: 1871704478
Provider Name (Legal Business Name): JAIME J MOURAD RDCS, RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5926 ALESSANDRO AVE APT 9
TEMPLE CITY CA
91780-1941
US

IV. Provider business mailing address

5926 ALESSANDRO AVE APT 9
TEMPLE CITY CA
91780-1941
US

V. Phone/Fax

Practice location:
  • Phone: 323-806-8414
  • Fax:
Mailing address:
  • Phone: 323-806-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number26552
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number26552
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number26552
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number26552
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number26552
License Number State
# 6
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: