=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508663683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GNOSIS FOR HER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2025
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 286 WINFIELD CIR
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92878-4343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-6611
-----------------------------------------------------
Fax | 714-202-6143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SPECTRUM CENTER DR STE 200
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-4987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-519-6611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MATTHEW COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-791-7881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------