Healthcare Provider Details

I. General information

NPI: 1194904839
Provider Name (Legal Business Name): ALPHA PORTABLE X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 CAMDEN BROOK ST
LAS VEGAS NV
89183-5642
US

IV. Provider business mailing address

11990 CAMDEN BROOK ST
LAS VEGAS NV
89183-5642
US

V. Phone/Fax

Practice location:
  • Phone: 702-875-1007
  • Fax: 702-431-3354
Mailing address:
  • Phone: 702-875-1007
  • Fax: 702-431-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number413784
License Number StateMN

VIII. Authorized Official

Name: MR. JUAN SOSA RIVERA
Title or Position: SECRETARY
Credential: RAD TECH RT
Phone: 702-580-1652