Healthcare Provider Details

I. General information

NPI: 1851379895
Provider Name (Legal Business Name): DYNAMIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 SIERRA LAUREL CT
HENDERSON NV
89014-8701
US

IV. Provider business mailing address

205 N STEPHANIE ST SUITE D #145
HENDERSON NV
89074-8115
US

V. Phone/Fax

Practice location:
  • Phone: 702-339-1560
  • Fax:
Mailing address:
  • Phone: 702-339-1560
  • Fax: 702-436-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. GEOFF A. GOODRICH
Title or Position: PRESIDENT
Credential: RVT
Phone: 702-339-1560