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General NPI Number Information
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NPI Number | 1508924796
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Entity Type | Organization
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Legal Business Name | MORENO VALLEY IMAGING, L.L.C.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12818 HEACOCK ST SUITE C2
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3173
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Country | US
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Telephone | 951-242-2508
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Fax | 951-242-2548
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Provider Business Mailing Address
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Address Line | 12818 HEACOCK ST SUITE C2
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3173
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Country | US
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Telephone | 951-242-2508
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Fax | 951-242-2548
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Authorized Official
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Title or Position | CFO
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Name | MR. BRIAN HENNEBRY
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Credential |
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Telephone | 951-242-2508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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