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General NPI Number Information
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NPI Number | 1033350574
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Entity Type | Organization
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Legal Business Name | JUBILEE RADIOLOGY, INC
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 550 E CARSON PLAZA DR STE 105
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City | CARSON
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State | CA
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Zip | 90746-7359
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Country | US
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Telephone | 310-630-5843
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Fax | 310-630-5844
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Provider Business Mailing Address
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Address Line | 550 E CARSON PLAZA DR STE 105
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City | CARSON
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State | CA
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Zip | 90746-7359
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Country | US
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Telephone | 310-630-5843
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Fax | 310-630-5844
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Authorized Official
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Title or Position | CEO
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Name | JANIS F. OWENS
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Credential | M.D.
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Telephone | 310-630-5843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | G46021
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License Number State | CA
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