=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093005076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURBANK OPEN MRI CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2011
-----------------------------------------------------
Last Update Date | 06/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 E MAGNOLIA BLVD STE 104
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-563-1674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 250610
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91225-0610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-291-0547
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARKETING DIRECTOR
-----------------------------------------------------
Name | MS. TAGUHI SOGOMONYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-291-0547
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------