Healthcare Provider Details

I. General information

NPI: 1487803268
Provider Name (Legal Business Name): CENTENNIAL MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 W CHEYENNE AVE SUITE 100
LAS VEGAS NV
89129-6759
US

IV. Provider business mailing address

7610 W CHEYENNE AVE SUITE 100
LAS VEGAS NV
89129-6759
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-7052
  • Fax:
Mailing address:
  • Phone: 702-942-1749
  • Fax: 702-685-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number11355
License Number StateNV

VIII. Authorized Official

Name: DR. VINAY KUNAR BARARIA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 702-942-1749