=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073296158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EBERLY IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2023
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13916 ELMCROFT AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-3710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-202-2349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13916 ELMCROFT AVE
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-3710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-202-2349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | EBER SANCHEZ ZELAYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 424-202-2349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471C3402X
-----------------------------------------------------
Taxonomy Name | Radiography Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------