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General NPI Number Information
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NPI Number | 1437171436
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Entity Type | Organization
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Legal Business Name | MIRAGE IMAGING CENTER FOR AETNA
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 15001 NATIONAL AVENUE
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-356-7226
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Fax | 408-356-7224
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Provider Business Mailing Address
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Address Line | 15001 NATIONAL AVENUE
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 973-931-6299
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Fax | 408-356-7224
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Authorized Official
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Title or Position | PRESIDENT
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Name | BULLAND ZAMAN
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Credential | MD
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Telephone | 973-931-6299
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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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