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General NPI Number Information
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NPI Number | 1609868488
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSIS PORTABLE X-RAY & EKG SERVICES INC. MDX
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 5627 SEPULVEDA BLVD
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City | VAN NUYS
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State | CA
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Zip | 91411-2920
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Country | US
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Telephone | 818-281-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4139 MAMMOTH AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-4323
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Country | US
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Telephone | 818-281-4000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BIALIK VAHDAT BENJAMIN
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Credential | CRT
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Telephone | 818-281-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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