=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285010736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONOGRAPHY INTERNATIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2015
-----------------------------------------------------
Last Update Date | 08/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3115 N FILBERT AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93727-9106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-575-5374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3115 N FILBERT AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93727-9106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-575-5374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MOISES PENA
-----------------------------------------------------
Credential | BSRT,RDMS,RDCS
-----------------------------------------------------
Telephone | 559-575-5374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------