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General NPI Number Information
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NPI Number | 1134317811
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Entity Type | Organization
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Legal Business Name | MIRACLE MILE CENTER FOR DIAGNOSTIC IMAGING
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 6200 WILSHIRE BLVD SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90048-5801
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Country | US
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Telephone | 323-933-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 WILSHIRE BLVD SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90048-5801
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Country | US
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Telephone | 323-933-1112
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | VANESSA HURTADO
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Credential |
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Telephone | 323-933-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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