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General NPI Number Information
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NPI Number | 1164423612
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Entity Type | Organization
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Legal Business Name | SAN BERNARDINO IMAGING LLC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 1884 BUSINESS CENTER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3457
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Country | US
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Telephone | 909-890-4090
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Fax | 909-890-4051
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Provider Business Mailing Address
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Address Line | 1884 BUSINESS CENTER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3457
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Country | US
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Telephone | 909-890-4090
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Fax | 909-890-4051
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MR. LAVELLE HARDIN
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Credential |
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Telephone | 615-344-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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