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General NPI Number Information
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NPI Number | 1205377686
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Entity Type | Organization
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Legal Business Name | IHEART IMAGING
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 722 GLENEAGLE AVE
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City | HAYWARD
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State | CA
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Zip | 94544-7208
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Country | US
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Telephone | 510-400-3829
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Fax |
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Provider Business Mailing Address
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Address Line | 722 GLENEAGLE AVE
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City | HAYWARD
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State | CA
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Zip | 94544-7208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CARDIOVASCULAR SONOGRAPHER
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Name | DIANA SY
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Credential | RDCS
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Telephone | 510-303-5810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 201632010237
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License Number State | CA
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