Healthcare Provider Details

I. General information

NPI: 1407694045
Provider Name (Legal Business Name): ELEVATED IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16333 WHITTIER BLVD
WHITTIER CA
90603-2906
US

IV. Provider business mailing address

16333 WHITTIER BLVD
WHITTIER CA
90603-2906
US

V. Phone/Fax

Practice location:
  • Phone: 562-550-4624
  • Fax:
Mailing address:
  • Phone: 562-550-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: GRISELDA SOLORZANO
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 626-780-0949